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Scientists at Children’s Health Research Institute (a program of Lawson Health Research Institute), Sunnybrook Research Institute and The Hospital for Sick Children (SickKids) are working together to study the potential benefits of inhaled sedation as an alternative to keep critically ill children sedated and comfortable.

“Many sick children need support from a ventilator and other life-saving treatments, and may require intravenous (IV) sedatives to tolerate these uncomfortable therapies,” says Dr. Rishi Ganesan, Lawson Associate Scientist and Paediatric Neurocritical Care Physician at Children’s Hospital at London Health Sciences Centre (LHSC). “However, our current sedation options may contribute to a complication called delirium. We are interested in evaluating if delirium and long-term neurological complications are lower in children receiving inhaled sedation compared to those receiving IV sedation, which is the current standard of care.” 

Delirium is an acute change in mental state that children in critical care can sometimes develop as a result of their critical illness and the medications and therapies they receive during their hospital stay. Delirium presents as confusion, disorientation, agitation, excessive drowsiness or poor attention. Dr. Marat Slessarev, Lawson Scientist and Critical Care Physician at LHSC, has been researching and comparing inhaled sedation to IV sedation in adults since the pandemic hit in 2020 in a collaborative trial called SAVE-ICU with Dr. Angela Jerath, Anesthesiologist and Scientist at Sunnybrook.

“One of the challenges with IV sedation is that we do not have a way to measure the level of sedatives in the blood,” explains Dr. Slessarev. “Critically ill patients that are sedated can sometimes develop issues with the kidney and liver, which are both important in eliminating the sedatives from the blood stream.”

Through this novel collaborative research, the team is now looking at the potential benefits of inhaled sedation in paediatric patients.

“Inhaled sedatives are an alternative to currently used IV sedatives, and they may reduce delirium and accelerate brain recovery. Inhaled sedatives are used safely every day in operating rooms, widely available and inexpensive,” explains Dr. Jerath. “In contrast to IV sedatives, they do not accumulate in the body, are rapidly eliminated via the lungs, promote faster awakening and discharge from a ventilator, and reduce inflammation – which may be a contributing factor to delirium.”

Enrollment for the ABOVE trial is beginning at Children’s Hospital at LHSC and SickKids. The pilot study will enroll 60 critically ill paediatric patients who will be randomized into two groups; one group will receive inhaled sedation while the other will get standard IV sedation. Once the pilot phase of the trial is complete, the team hopes to expand this trial across the country with more paediatric intensive care units (ICUs) joining the larger trial.

“The field of critical care has made significant strides in life-saving technologies and therapies in recent years, but now we are focused on finding ways to ensure our patients continue to do well after leaving the hospital,” says Dr. Nicole McKinnon, Critical Care Physician and lead investigator at SickKids and a Scientist Track Investigator at SickKids Research Insitute. “This trial is a first step in better understanding the effects of sedative and pain medications on children’s longer-term neurocognitive development. Our research will be key to providing critically ill children with the greatest chance to flourish at home.”

“This has the potential to change how critically ill children are cared for in paediatric ICUs across Canada and the world,” adds Dr. Ganesan. “We hope that inhaled sedation makes a difference in children’s long-term functional outcomes, so they can thrive and achieve their full potential.” 

The ABOVE Trial recently received funding through a Canadian Institute for Health Research (CIHR) grant.

About Sunnybrook Research Institute: Sunnybrook Research Institute (SRI) is the research arm of Sunnybrook Health Sciences Centre, an internationally recognized academic health sciences centre fully affiliated with the University of Toronto. With well-established programs in basic and applied sciences which span across three scientific platforms and ten clinical programs, SRI is developing innovations in care for the more than 1.3 million patients the hospital cares for annually. To learn more, visit www.sunnybrook.ca/research

About The Hospital for Sick Children: The Hospital for Sick Children (SickKids) is recognized as one of the world’s foremost paediatric health-care institutions and is Canada’s leading centre dedicated to advancing children’s health through the integration of patient care, research and education. Founded in 1875 and affiliated with the University of Toronto, SickKids is one of Canada’s most research-intensive hospitals and has generated discoveries that have helped children globally. Its mission is to provide the best in complex and specialized family-centred care; pioneer scientific and clinical advancements; share expertise; foster an academic environment that nurtures health-care professionals; and champion an accessible, comprehensive and sustainable child health system. SickKids is a founding member of Kids Health Alliance, a network of partners working to create a high quality, consistent and coordinated approach to paediatric health care that is centred around children, youth and their families. SickKids is proud of its vision for Healthier Children. A Better World.

LONDON, ON – The unique and challenging experiences faced by Canadian Armed Forces (CAF) Veterans puts this group at high risk for developing symptoms of mental health disorders, such as Post traumatic stress disorder (PTSD), depression, and anxiety. Researchers at Lawson Health Research Institute (Lawson) have been awarded over $40,000 from Veterans Affairs Canada to study various risk and protective factors associated with mental health disorders in CAF Veterans.  

The study aims to learn whether an individual’s personality traits serve as risk or protective factors for Veterans developing mental health problems. The traits that will be examined include openness, agreeableness, emotionality, honesty-humility, conscientiousness, extraversion, and resiliency. For example, someone who is high in openness and resiliency may have a lower risk of developing mental health symptoms.  

“Veterans and military members experience uniquely challenging events when compared to the general population,” explains Dr. Rachel Plouffe, study co-lead and Postdoctoral Associate at Lawson. “Past research has identified some risk factors, including history of childhood trauma, age, gender, and education. However, no one to date has investigated the role that personality traits might play in Veterans’ symptoms of mental health conditions.”  

The research team will look at the relationship between these personality traits, exposure to stressful experiences during military operations, and mental health outcomes through survey data provided by 500 treatment-seeking and non-treatment seeking Veterans. This information will be used to assess whether the individual’s expression of these personality traits can predict levels of depression, anxiety and PTSD.  

They also hope to determine whether the association between combat exposure and PTSD is stronger for those higher in traits such as emotionality, which reflects those who tend to be anxious and fearful. On the other hand, this association will likely be weaker for those higher in more “positive” traits, such as agreeableness, as these individuals tend to be cooperative and forgiving toward others.  

Plouffe notes that personalities are not completely stagnant. Certain traits can often change over time, and individuals can work to increase their levels of resiliency.  

“Ultimately, our hope is to help improve the ability of CAF members and Veterans to thrive even in the face of great adversity. With the findings from our research, military organizations and mental health treatment centres could use the information from this study to predict which patients may be at greater risk of developing mental health disorders, and provide tailored treatment for these individuals,” she explains.  

“This research is needed for military organizations to improve and implement strategies that enhance the well-being of Veterans and active service members,” says Dr. Don Richardson, study co-lead and Director of the MacDonald Franklin OSI Research Centre at Lawson. “Our Veterans give a lot to serve and protect, so it is our duty as researchers and clinicians to find ways that we can better serve them.” 

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LONDON, ON - A team from Lawson Health Research Institute is seeking 500 Canadian health care workers to participate in a study on moral distress and psychological wellbeing during the COVID-19 pandemic. Participants will complete online surveys once every three months for a total of 18 months. The goal is to better understand the pandemic’s impact on health care workers in order to minimize moral distress and support wellbeing during future pandemic events.  

Moral distress is a form of psychological distress that occurs following an event that conflicts with a person’s moral values or standards. Through previous research with military populations, moral distress has been linked to an increased risk of post-traumatic stress disorder (PTSD) and depression.
 
“Health care workers are facing unprecedented demands as a result of the pandemic and many may be working under extreme physical and psychological stress,” says Dr. Don Richardson, Lawson Associate Scientist and Director of the MacDonald Franklin Operational Stress Injury (OSI) Research Centre. “Health care workers may face difficult moral-ethical decisions including those around patient care and shortages of personal protective equipment (PPE), which could lead to moral distress.”

The study will consist of a series of surveys to assess moral distress during the pandemic. Participating health care workers will answer questions about moral-ethical dilemmas and symptoms of depression, PTSD, general anxiety, and burnout. 

“Moral-ethical dilemmas must be considered in the context of other difficulties faced by health care workers during the pandemic, such as increased workloads, reduced social activities, and evolving work environments and health care delivery models,” explains Dr. Anthony Nazarov, Associate Scientist at Lawson and the MacDonald Franklin OSI Research Centre. 

The team hopes that results can be used to cultivate wellness at the outset of future pandemics. This might include guiding emergency preparedness policies and moral-ethical decision-making training modules. They hope that by tracking psychological outcomes over time, they can identify early warning signs of distress that can be targeted with early interventions. 

The researchers will also ask questions that explore how the pandemic is impacting health care delivery, such as increased reliance on virtual care appointments, and whether health care workers are satisfied with these changes. 

“It is necessary to provide a voice to health care workers during this pandemic,” adds Dr. Richardson. “This is the first study to measure the moral-ethical dilemmas faced in a pandemic and the impacts of such dilemmas on moral distress. It is also the first to measure health care worker perceptions on the virtual migration of patient care.”

This project is in partnership with the Centre of Excellence on PTSD and Related Mental Health Conditions. The focus of the Centre of Excellence is to create knowledge networks across Canada to increase expertise and create the best possible supports and services for Veterans, first responders and their families.

Interested Canadian health care workers can learn more about the study and access the survey at https://participaid.co/studies/bYE4Ob.

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