- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04821453
NAVA vs. CMV Crossover in Severe BPD
August 8, 2023 updated by: Children's Hospital of Philadelphia
Pilot Cross-Over Trial of Neurally Adjusted Ventilatory Assist (NAVA) and Conventional Flow Triggered Mechanical Ventilation (CMV) in Severe Bronchopulmonary Dysplasia (sBPD)
This prospective, unblinded, pilot randomized cross-over trial of 2 modes of mechanical ventilation will compare measures of pulmonary mechanics, respiratory gas exchange, and patient comfort between conventional flow triggered mechanical ventilation and neurally adjusted ventilatory assist (NAVA) among 20 prematurely born infants and young children receiving invasive respiratory support for severe bronchopulmonary dysplasia (BPD).
Study Overview
Status
Recruiting
Intervention / Treatment
Detailed Description
Most research to date in neonatal lung disease has focused on bronchopulmonary dysplasia (BPD) prevention.
As a result, insufficient investigation has been performed to define optimal respiratory management strategies for infants and young children with established BPD.
Thus, there is no robust evidence base to guide ventilator management to promote lung disease recovery and support neurodevelopment in this population.
Neurally adjusted ventilatory assist (NAVA) is an alternative to conventional flow triggered ventilation that has shown promise for improving respiratory gas exchange, patient-ventilator interaction, and work of breathing in preterm neonates.
The safety and efficacy of NAVA in infants and young children with established, severe BPD is uncertain.
This prospective, unblinded, pilot randomized cross-over trial of 2 modes of mechanical ventilation will compare measures of pulmonary mechanics, respiratory gas exchange, and patient comfort between conventional flow triggered mechanical ventilation and NAVA among 20 prematurely born infants and young children receiving invasive respiratory support for severe BPD.
Study Type
Interventional
Enrollment (Estimated)
25
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Natalie Napolitano, MPH, RRT-NPS
- Phone Number: 215-590-1708
- Email: napolitanon@chop.edu
Study Locations
-
-
Pennsylvania
-
Philadelphia, Pennsylvania, United States, 19104
- Recruiting
- Children's Hospital of Philadelphia
-
Contact:
- Natalie Napolitano, MPH, RRT-NPS
- Phone Number: 215-590-1708
- Email: napolitanon@chop.edu
-
-
Rhode Island
-
Providence, Rhode Island, United States, 02903
- Recruiting
- Rhode Island Hospital (Hasboro Children's Hospital)
-
Contact:
- Robin I McKinney, MD
- Email: Robin.McKinney@Lifespan.org
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
No older than 2 years (Child)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Gestational ages (GA) ≤ 32 weeks
- Current age between 36 weeks postmenstrual age (PMA) and 2 years corrected age
- Severe BPD [as per National Institutes of Health (NIH) consensus definition] diagnosed at 36 weeks postmenstrual age
- Receiving invasive mechanical ventilation for ongoing lung disease
- Not expected to be ready for extubation within 11 days following enrollment
- Parental consent
Exclusion Criteria:
- Severe congenital anomalies
- Known diaphragmatic defect
- Current treatment with high frequency mechanical ventilation
- Do not resuscitate (DNR) Status or Futility of Care
- >10% leak around the artificial airway,
- Treatment with neuromuscular blockade within 72 hours prior to enrollment
- Acute respiratory instability defined as a ventilator rate increase > 15 beats per minute (bpm), Positive end-expiratory pressure (PEEP) increase > 2 cm/water (H2O), sustained FiO2 increase > 20%, and/or prescribed increase in tidal volume > 2 mL/kg within 24 hours prior to enrollment will be excluded.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Placebo Comparator: Conventional Flow Triggered Mechanical Ventilation (CMV)
Subjects will be ventilated with conventional mechanical ventilation with data collected for the 5 day time frame to compare to the experimental arm
|
CMV mode of mechanical ventilation that provides a trigger for a spontaneous breath from the airway flow sensor with dynamics of the breath set as required by the mode
Other Names:
|
Experimental: Neurally Adjusted Ventilatory Assist (NAVA)
Subjects will be ventilated on neurally adjusted ventilatory assist (NAVA) mode with data collected for the 5 day time frame to compare with placebo arm
|
NAVA mode of mechanical ventilation provide the trigger for a spontaneous breath from the diaphragmatic movement instead of diaphragm and allows the patient to control the dynamics of the breath generally set in CMV mode.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Oxygen saturation (SpO2) index
Time Frame: up to 5 days per study arm
|
Oxygen saturation index will be measured by assessing if invasive mechanical ventilation with NAVA compared to CMV improves respiratory gas exchange in patients receiving invasive respiratory support for BPD.
This will be calculated as the median, time-weighted daily oxygen saturation (SpO2) index ([mean airway pressure x Fraction of inspired oxygen (FiO2)]/SpO2).
|
up to 5 days per study arm
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Sedation Medications
Time Frame: up to 5 days per study arm
|
The need for sedation medication will be assessed by comparing the needs for sedation by the total daily dose milligram/kilogram (mg/kg) of sedation medications on invasive mechanical ventilation with NAVA compared to CMV.
|
up to 5 days per study arm
|
Stress
Time Frame: up to 5 days per study arm
|
Patient stress will be assessed by collecting salivary swabs three times per day to measure cortisol levels.
The daily average will be assessed and compared as a marker for patient stress on invasive mechanical ventilation with NAVA compared to CMV.
|
up to 5 days per study arm
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Erik Jensen, MD, MSCE, Children's Hospital of Philadelphia
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
September 13, 2021
Primary Completion (Estimated)
October 1, 2025
Study Completion (Estimated)
October 1, 2025
Study Registration Dates
First Submitted
March 23, 2021
First Submitted That Met QC Criteria
March 26, 2021
First Posted (Actual)
March 29, 2021
Study Record Updates
Last Update Posted (Actual)
August 9, 2023
Last Update Submitted That Met QC Criteria
August 8, 2023
Last Verified
August 1, 2023
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 19-017175
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
Yes
product manufactured in and exported from the U.S.
Yes
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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