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 Prof Adrienne Randolph (Boston)

Viewer's Questions

Dr Chris Nutt (Belfast, Northern Ireland)

Answers from chief investigator Dr Padmanabhan Ramnarayan (London).

Panel Discussion

Rob Mac Sweeney hosts a panel discussion including Prof Martha A.Q. Curley (Philadelphia), Assoc Prof Christopher M. Horvat (Pittsburgh), Prof Martin Kneyber (Groningen), and Prof David Harrison (London). They are joined by Dr Padmanabhan Ramnarayan (chief investigator), Mr Alvin Richards-Belle (trial manager) and Prof Adrienne Randolph (editorialist).

Audio Version

Audio Version

Audio Version

The Trial

FIRST-ABC is a master protocol combining two randomised controlled trials evaluating high flow nasal oxygen and continuous positive airwar pressure in children with respiratory failure.

The first trial (step down) compares the use of these two interventions in recently extubated children. The second trial (step up) compares these therapies in children with acute illness and respiratory failure.

The results of the step down trial will be presented at a Critical Care Reviews Trial Results Livestream on Thursday, April 7th, 19:30 UTC+1.

The results of the step up trial will be presented at CCR22, in Titanic Belfast, June 15th to 17th.

Selected Global Timings


21:30 to 23:10


20:30 to 22:10


19:30 to 21:10

São Paulo

15:30 to 17:10


14:30 to 16:10

Mexico City

13:30 to 15:10

Suva (8th)

06:30 to 08:10

Singapore (8th)

02:30 to 04:10

New Delhi (8th)

00:00 to 01:40


FRIST-ABC Trial Results

Padmanabhan Ramnarayan


Adrienne Randolph

Reply to the Editorial

Padmanabhan Ramnarayan

Viewer's Questions

Chris Nutt

Panel Discussion

Martha Curley

Christopher Horvat

Martin Kneyber



Padmanabhan Ramnarayan

Paediatric Intensivist, Imperial College, London

Dr Padmanabhan Ramnarayan, MD (Ram) is Reader in Paediatric Critical Care at Imperial College and Consultant in Paediatric Intensive Care at St Mary's Hospital in London. He has a long-standing research interest in the epidemiology of paediatric critical illness (including the effects of centralisation of specialist care), provision of non-invasive respiratory support, and pragmatic clinical trials in critical care. He is currently leading the FIRST-ABC master protocol, the largest clinical trial comparing nasal high-flow with continuous positive airway pressure in acutely ill children (step-up RCT) and following extubation (step-down RCT). He is also a co-investigator on some of the ongoing pragmatic clinical trials in paediatric critical care (Oxy-PICU, PRESSURE) and has received over £6 million in NIHR funding over the past 3 years. In the past, Ram has led the DEPICT Study (NIHR HSDR) and been a co-investigator on the CATCH trial (NIHR HTA).

Ram has published extensively (>100 peer-reviewed articles), written several book chapters and lectures regularly at national and international scientific meetings. He regularly reviews articles for high-impact journals including the New England Journal of Medicine, the Lancet and Pediatric Critical Care Medicine. Ram is the current Chair of the Paediatric Critical Care Society Study Group (PCCS-SG), the national paediatric critical care research group, and holds national leadership roles in the NHS England Clinical Reference Group and the Paediatric Intensive Care Audit Network (PICANet).

Twitter:  @pic_pram

Alvin Richards-Belle

Clinical Trials Manager at the ICNARC Clinical Trials Unit, London, England

Dr Richards-Belle has an academic background in Psychology (University of Southampton) and over 8 years’ experience working on and managing large-scale randomised clinical trials and observational cohort studies in the field of critical care at the Intensive Care National Audit & Research Centre (ICNARC). Studies included: the evaluation of a complex psychological intervention aimed at preventing the development of PTSD symptoms in patients recovering from critical illness and epidemiological studies exploring the first epidemic wave of COVID-19 in critical care.

Twitter: @Alvin_R_B

Adrienne Randolph

Professor of Anesthesia and Pediatrics at Harvard Medical School

Dr. Randolph is Professor of Anesthesia and Pediatrics at Harvard Medical School and a Senior Associate in Critical Care Medicine at Boston Children’s Hospital in Massachusetts, USA . She has been an attending physician in the Medical-Surgical pediatric ICU there for over 20 years. Dr. Randolph is the founder and first Chair of the Pediatric Acute Lung Injury and Sepsis Investigator’s (PALISI) Network, a clinical research consortium of over 80 pediatric ICUs in the U.S. and Canada.  She has been a Council member of the International Sepsis Forum since 2011 and is active in many other professional societies including the Society for Critical Care Medicine, the Society for Pediatric Research and the American Thoracic Society.  She helped lead the consensus meeting where the 2005 definition of sepsis in infants and children was developed and has coauthored multiple national guidelines on sepsis diagnosis and management practices for adults and children. She has published multicenter trials and cohort studies in the area of sepsis, acute lung injury and severe pneumonia in children.  She leads a 40 center Pediatric Critical Care Influenza (PICFLU) Study Group investigating genetic susceptibility and immune response in children with influenza-related sepsis.

Christopher M. Horvat

Assistant Professor of Critical Care Medicine and Pediatrics, UPMC Children's Hospital of Pittsburgh

Dr. Horvat is board-certified in Pediatrics, Pediatric Critical Care Medicine and Clinical Informatics. His academic interests focus on the National Academy of Medicine's Learning Health System concept. He is currently funded by a K23 career development award (1K23HD099331-01A1) titled "A Learning Health System Approach to Precision Sedation and Analgesia in Critically Ill Children" from the National Institute for Child Health and Human Development (NICHD). In his current work, Dr. Horvat aims to utilize a combination of electronic health record-derived datasets, pharmaco kinetic models and pharmacogenomic insights to develop advanced clinical decision support tools to help refine the use of potent sedatives and analgesic medications in the pediatric intensive care unit.

He also serves a number of other roles in clinical informatics, including leading the development of informatics-integrated multidisciplinary workflows for detecting and treating pediatric sepsis, spearheading the creation of artificial intelligence tools for predicting inpatient pediatric deterioration events, and helping to deploy randomized, embedded, multifactorial, adaptive, platform (REMAP) trials across the UPMC system.

Martha A.Q. Curley

Chair in Pediatric Nursing at the Children’s Hospital of Philadelphia and Professor at the University of Pennsylvania

Dr. Martha A. Q. Curley is the Ruth M. Colket Endowed Chair in Pediatric Nursing at the Children’s Hospital of Philadelphia and Professor at the University of Pennsylvania School of Nursing. She also holds a joint appointment in Anesthesia and Critical Care Medicine at the University’s Perelman School of Medicine. Her research, funded in the United States by the NHLBI, NINR and NICHD, has focused on nurse-implemented interventionsin pediatric critical care.Over several decades, her studies have informed the practice of caring for critically-ill pediatric patients with acute respiratory failureand haveilluminated relationship-based care when partnering with parents-of-critically-ill childrenThis year Marthawill receive Society of Critical Care Medicine’s, Drs. Vidyasagar and Nagamani Dharmapuri Award for sustained exemplary and pioneering achievements in the care of critically ill and injured infants and children.In addition, Dr.Curley has led the development and dissemination ofcore metrics in the field of pediatrics; for example, the State Behavioral Scale(SBS), the Withdrawal Assessment Tool (WAT-1), individualized numeric rating scale (INRS) and the Braden QDscale. Dr. Curley is a member of the NationalAcademy of Medicine (IOM) and a fellow in the American Academy of Nursing(FAAN). Martha received her diploma in nursing from Springfield Hospital School of Nursing, her BSfrom the University of Massachusetts at Amherst,

Twitter:  @maqcurley

Martin Kneyber

Chief of the Division of Paediatric Critical Care Medicine at the Beatrix Children’s Hospital, Groningen, the Netherlands

Dr. Martin Kneyber (1972) is Chief of the Division of Paediatric Critical Care Medicine at the Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, the Netherlands. Dr. Kneyber obtained his medical degree in 1998 (cum laude) at the Erasmus University Rotterdam and completed his specialist training in Paediatrics in 2003 at the Wilhelmina Children’s Hospital, Utrecht. Since 2005 he is board certified in paediatric critical care. Dr. Kneyber completed a PhD thesis in 2000 at the Erasmus University Rotterdam. He is a fellow of the American College of Critical Care Medicine.

Dr. Kneyber serves as Medical President-Elect of the European Society for Paediatric and Neonatal Intensive Care (ESPNIC). He is a member of the editorial board of Pediatric Critical Care Medicine and frequently reviews for international journals in the field of critical care medicine.

His main academic interest relates to paediatric mechanical ventilation. He is the PI for the PAN (Paediatric Ards Neuromuscular blockade) study funded by ZonMW and MPI for PROSpect (Prone and Oscillation pediatric clinical trial) funded by the NIH/NHLBI. Dr. Kneyber has published more then 180 scientific papers and contributed to numerous book chapters. He frequently gives invited lectures and workshops at international critical care conferences.

Twitter:  @Martin_Kneyber

David Harrison

Senior Statistician at the Intensive Care National Audit & Research Centre

Prof David Harrison graduated from the University of Cambridge with an MA in mathematics and a PhD in mathematical modelling of disease progression. He has worked for ICNARC since 2002. David is a Fellow of the Royal Statistical Society and an Honorary Professor in the Medical Statistics Unit of the London School of Hygiene & Tropical Medicine.

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