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; clinical decision support systems based on artificial intelligence and machine learning methods to analyse time-series physiological data to speed up ventilator liberation; population-health approaches focusing on paediatric critical care epidemiology; and personalised medicine through the identification of blood, breath and vital signs-based biomarkers.

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 provided, even routinely, 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. Both at a population level and at individual patient level, understanding how care can be improved is a crucial part of improving outcomes for sick children.

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. Understanding how clinical services can be set up differently to improve the outcomes and patient/family experience for sick children is important for policy makers as well as patients/families. 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, BACHb Trial
  • Pragmatic clinical trials: Oxy PICU, PRESSURE
  • Platform trial in UK PICUs: PIVOTAL
  • Ventilator liberation
  • Critical care transition from paediatric to adult: OPTICAL study
  • Social determinants of paediatric critical care admission: Privacy notice
  • Metabolomic analyses in critically ill children
  • Gene expression markers of steroid responsiveness in paediatric sepsis
  • Breath analysis to diagnose respiratory tract infections




  • 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