REMAP REST EEC (Rest Easy: Respiratory Support and Treatment for Efficient and Cost-Effective Care)

Grant Application

Christopher Horvat, MD, MHA

Proposed Innovation

Respiratory disease is the most common reason children are admitted to the hospital. Between 2018 and 2021, UPMC Children’s Hospital of Pittsburgh admitted and treated 10,784 children with asthma, 5,242 VERIFY children with bronchiolitis, and 6,076 children with pneumonia. Many of these diseases were once commonly fatal, but treatment advances over the past several decades have made deaths rare.

One common treatment used for children is the heated high-flow nasal cannula therapy (HHFNC). Despite a growing chorus of calls to standardize the use of HHFNC, there is increasing concern nationally and internationally about the overuse of this therapy, the potential for unnecessary cost, and even patient harm. The “Rest Easy” project will examine the safety and effectiveness of heated high-flow nasal cannula therapy in children with respiratory conditions.

Improvements in Action

Standardizing the use of HHFC is currently a national quality improvement priority of the American Academy of Pediatrics. However, there are no rigorous, large scale, randomized controlled trial data to support such an initiative. This is important because enacting standardized care will require substantial resources for both implementation and ongoing maintenance phases.

The Randomized, Embedded Multifactorial Adaptive Platform (REMAP) REST EEC trial (Rest Easy: Respiratory Support and Treatment for Efficient and Cost-Effective Care) will focus specifically on whether this new therapy should be used for all pediatric patients with a respiratory illness.

Intended Outcomes

The REMAP “Rest Easy” project is expected to show that standardized use of HHFNC, including an assessment of patient breathing and weaning off HHFNC will result in more days free of oxygen support.