- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05839340
Neurally Adjusted Ventilatory Assist for Neonates With Congenital Diaphragmatic Hernias (NAN-C)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Background:
Congenital Diaphragmatic Hernias (CDH) are typically repaired surgically in the first few days of a neonate's life. Following surgical repair, infants usually require ventilatory support to ensure adequate oxygenation. Traditionally assist control ventilation (ACV) has been used to support neonates with CDH. Due to delivering a fixed pressure of oxygen, ACV has been associated with barotrauma and long-term lung damage. A more recent approach to ventilation is non-invasive neurally adjusted ventilatory assist (NIV-NAVA). NIV-NAVA uses electrical signals of the diaphragm to deliver a proportional pressure of oxygen. Evidence suggests that NAVA may reduce physiological parameters associated with lung pressure and hence reduce the risk of iatrogenic lung injury.
Aims:
Our aim is to compare the oxygenation index (OI) of neonates with CDH, ventilated with ACV and NIV-NAVA. The OI is calculated as the fractured of inspired oxygen x mean airway pressure x partial pressure of oxygen/100. The oxygenation index is used as a marker of hypoxic respiratory failure in infants with CDH and forms the basis of the criteria to administer nitric oxide.
Methods:
Our investigation is a dual-centre randomised cross-over trial. Infants will be identified and parents counselled in the first few days following delivery. Neonates that meet inclusion criteria will be randomised to receive either NIV-NAVA or ACV first, followed by the other method of ventilation. Infants will be stabilised on ACV one-hour prior to entering the trial. On entry into the trial, they will receive 4-hours of each ventilatory method with a 20-minute stabilisation break in between.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Anne Greenough, Professor
- Phone Number: 020 3299 3105
- Email: anne.greenough@kcl.ac.uk
Study Locations
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London, United Kingdom
- Kings College Hospital
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London, United Kingdom
- St. George's University Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Infants born with congenital diaphragmatic hernia more than 34-weeks gestation
Exclusion Criteria:
- Receiving Nitric Oxide
- Requiring an FIO2 more than 80% to maintain SpO2: 85-95%.
- Severe chromosomal abnormality
- Severe cardiac anomalies requiring corrective surgery
- Renal anomalies
- Skeletal deformities suspected to impede thoracic or lung development
- Severe central nervous system anomalies suspected to impede diaphragmatic signalling
- Use of neuromuscular blocking agents
- Contraindication to nasogastric tube insertion
Study Plan
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 |
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Experimental: Assist Control Ventilation (ACV)
Infants will first be ventilated with ACV for four hours.
Following this, they will undergo a 20-minute stabilisation period prior to ventilating with non-invasive neurally adjusted ventilatory assist.
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ACV delivers fixed oxygen pressure set by the clinician at the start of each inspiratory breath.
NAVA uses electrical signals of the diaphragm to deliver a proportional pressure of oxygen, to which proportion is set by the clinician as the NAVA level.
Other Names:
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Experimental: Neurally Adjusted Ventilatory Assist
Infants will first be ventilated with NAVA for four hours.
Following this, they will undergo a 20-minute stabilisation period prior to ventilating with assist control ventilation (ACV).
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ACV delivers fixed oxygen pressure set by the clinician at the start of each inspiratory breath.
NAVA uses electrical signals of the diaphragm to deliver a proportional pressure of oxygen, to which proportion is set by the clinician as the NAVA level.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Oxygenation Index (OI)
Time Frame: Infants will receive each mode of ventilation for four hours. OI will be recorded every 5-minutes for the final 30-minutes of each ventilation period. The OI will be averaged over the 30-minute time frame. This average OI will then be compared.
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Oxygenation Index is calculated as MAP x FIO2 x PaO2/100.
MAP is the mean airway pressure.
FIO2 represents the concentration of inspired oxygen and PAO2 is the partial pressure of oxygen.
The OI is a reliable indicator of lung function, previous research has shown its use in the prognostication of neonates with CDH.
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Infants will receive each mode of ventilation for four hours. OI will be recorded every 5-minutes for the final 30-minutes of each ventilation period. The OI will be averaged over the 30-minute time frame. This average OI will then be compared.
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Respiratory Severity Score (RSS)
Time Frame: RSS will be recorded every 5-minutes for the final 30-minutes that the infant is on each ventilation mode. This will be compared to their baseline 30-minutes pre-randomisation and between ventilation modes.
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The respiratory severity score is calculated as RSS = FIO2 x MAP.
Where FIO2 represents the fraction of inspired oxygen and MAP is the mean airway pressure.
In one multivariate analysis of 59 infants with CDH, RSS was an effective prognostic marker.
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RSS will be recorded every 5-minutes for the final 30-minutes that the infant is on each ventilation mode. This will be compared to their baseline 30-minutes pre-randomisation and between ventilation modes.
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Morphine Equivalent Use
Time Frame: The cumulative total of morphine used during the four-hour period on each ventilation mode will be calculated. This will be compared between ventilation modes.
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Analgesic medication will be used with a basal-bolus regimen with the option for as required analgesia based on perceived pain and agitation.
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The cumulative total of morphine used during the four-hour period on each ventilation mode will be calculated. This will be compared between ventilation modes.
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Midazolam Equivalent Use
Time Frame: The cumulative total of midazolam, or equivalent benzodiezapine, used during the four-hour period on each ventilation mode will be calculated. This will be compared between ventilation modes
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Cumulative midazolam use on each ventilatory method will be calculated.
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The cumulative total of midazolam, or equivalent benzodiezapine, used during the four-hour period on each ventilation mode will be calculated. This will be compared between ventilation modes
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Mean Airway Pressure (MAP)
Time Frame: MAP will be recorded every 5-minutes for the final 30-minutes that the infant is on each ventilation mode. This will be compared to their baseline 30-minutes pre-randomisation and between ventilation modes.
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The MAP is mean pressure the lungs are exposed to during inspiration and expiration.
Mean airway pressure is one of the main determinants of oxygenation.
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MAP will be recorded every 5-minutes for the final 30-minutes that the infant is on each ventilation mode. This will be compared to their baseline 30-minutes pre-randomisation and between ventilation modes.
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Fraction of Inspired Oxygen (FIO2)
Time Frame: FIO2 will be recorded every 5-minutes for the final 30-minutes that the infant is on each ventilation mode. This will be compared to their baseline 30-minutes pre-randomisation and between ventilation modes.
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The FIO2 is the concentration of oxygen delivered expressed as a percentage.
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FIO2 will be recorded every 5-minutes for the final 30-minutes that the infant is on each ventilation mode. This will be compared to their baseline 30-minutes pre-randomisation and between ventilation modes.
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Peak Inspiratory Pressure (PIP)
Time Frame: PIP will be recorded every 5-minutes for the final 30-minutes that the infant is on each ventilation mode. This will be compared to their baseline 30-minutes pre-randomisation and between ventilation modes.
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Peak Inspiratory Pressure is defined as the pressure reached at the end of inspiration.
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PIP will be recorded every 5-minutes for the final 30-minutes that the infant is on each ventilation mode. This will be compared to their baseline 30-minutes pre-randomisation and between ventilation modes.
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Collaborators and Investigators
Collaborators
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 319769
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
It is our intent that the NAN-C protocol will be published, following SPIRIT guidelines, following the start of the trial.
At present, there are no plans to grant public access to the full protocol, participant-level data set or statistical code. For 6-months following publication of the final study results, investigators will be granted priority for secondary data analyses. Following this period, requests for de-identified data will be considered. Requests for data presented in the final paper should be submitted via email to Professor Anne Greenough.
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- ICF
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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