Padmanabhan Ramnarayan 

What we do

The focus of our research is to improve outcomes for critically ill children who need intensive care. We are doing this through a combination of methods: pragmatic clinical trials, particularly of breathing support interventions, to understand which ones work best for children; clinical decision support systems based on artificial intelligence and machine learning techniques analysing time-series physiological data to speed up ventilator liberation; and identification of biomarkers to help deliver personalised medicine.

Why it is important

Each year over 20,000 children are admitted to intensive care units across the UK. Many require planned intensive care after complex surgery, but the majority require unplanned admission for acute emergencies such as breathing problems, sepsis, and accidents/trauma. Improving outcomes for this vulnerable group of children can have an enormous impact on survival as well as their longer-term health.

Most interventions in paediatric critical care are not evidence-based, meaning that their benefits and risks as well as costs are not clear. Generating robust evidence through clinical trials is an important way to provide cost-effective high-quality clinical care. Similarly, time-series physiological data is abundant in critical care, so using it to its full potential is important to help clinicians.

How it can benefit patients

Our research is very clinically focused. Understanding through clinical trials which breathing support treatments are effective (and which ones are not) will help clinicians choose the most appropriate treatment for children in the right clinical scenario. Getting children off the ventilator is an important clinical goal and developing artificial intelligence systems to guide clinicians to achieve this will lead to many more children coming off ventilators early and breathing for themselves, minimising the complications of ventilation. Personalising treatment to children by understanding the biological mechanisms by which they have become unwell is an important area of research that will help clinicians treat patients individually rather than using a ‘one-size-fits-all’ approach.

Summary of current research

  • Non-invasive respiratory support (high flow nasal cannula, CPAP): FIRST ABC Trial
  • Negative pressure ventilation
  • Pragmatic clinical trials (Oxy PICU, PRESSURE)
  • Ventilator liberation
  • Biomarkers of disease severity (risk stratification)
  • Gene expression markers of steroid responsiveness in sepsis




  • Professor Elizabeth Draper (University of Leicester)
  • Sarah Seaton (University of Leicester)
  • Professor Kathy Rowan (ICNARC)
  • Professor David Harrison (ICNARC)
  • Paul Mouncey (ICNARC)
  • Professor Jo Wray (Great Ormond Street)
  • Professor Christina Pagel (UCL)
  • Professor Mark Peters (UCL)
  • Samiran Ray (Great Ormond Street)
  • Professor Steve Morris (Cambridge)
  • Professor Richard Grieve (LSHTM)
  • Zia Sadique (LSHTM)


  • Professor Michael Levin
  • Aubrey Cunnington
  • Jethro Herberg
  • Myrsini Kaforou
  • Peter Buckle
  • Dougal Hargreaves
  • Professor Aldo Faisal (Computing)
  • Professor Anthony Gordon


  • Pal Bhusate, Kinseed

Clinical trials

  • FIRST ABC Trial
  • Oxy PICU Trial
  • PRESSURE Trial