Clinical Research Directory

Inclusion Criteria: * PICU admission at one of the study sites in which elements of R2 are typically but sporadically implemented * Transferred to the PICU from another hospital unit/ward with ≤4 nights in the hospital (≤2 nights in PICU) * Between the ages 6 months and 18 years at the time of enrollment (has not had their 18th birthday) * Intubated and mechanically ventilated for acute airway or parenchymal disease within last 48 hours * Expected to be intubated for more than 12 hours past enrollment * Parent/Guardian providing consent, provides primary care for subject Exclusion Criteria: * A baseline cognitive dysfunction, measured by the Pediatric Cerebral Performance Category (PCPC ≥4) * A history of an uncontrolled seizure disorder (seizure within past 3 months), cerebral hypertension, neuromuscular respiratory failure, ventilator dependence (excluding BiPAP or CPAP at night) * A history of inability to tolerate bolus enteral feeds (full J-Tube fed patients) * The presence of any of the following within 24 hours of admission: * Modal pain scores greater than 4 * Persistent hypotension/hypertension unresponsive to standard therapies * Use of High Frequency Oscillatory Ventilation or Extracorporeal Membrane Oxygenation * Administered melatonin within the past week * Has an active do-not-resuscitate plan