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Use of High Flows in Pediatric Cardiac Surgical Patients

21. august 2012 opdateret af: Francesca Giovanna Iodice, Bambino Gesù Hospital and Research Institute

Use of High Flow Ventilation in Pediatric Cardiac Surgical Patients

Humidified high flow nasal prong oxygen therapy is a method for providing oxygen and CPAP. The delivery of high flows decreases dilution of the inhaled oxygen and, by matching patient's peak flow, allows accurate delivery of the set FiO2 throughout the whole inspiratory phase. In addition, a flow-dependent effect of continuous positive airway pressure, possibly due to an air entrainment mechanism, has been documented in healthy volunteers and in patients with COPD.

The investigators working hypothesis is that the use of post-extubation CPAP delivered via nasal cannulae in infants less than 18 months, post-bypass surgery will have better PaCO2 values than infants extubated on to oxygen therapy.

Studieoversigt

Status

Ukendt

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

After CICU admission, infants with no bleeding, normothermic and hemodynamically stable will be switched from PRVC to SIMV+PSV (10-15cmH20) which should be maintained for 4 hours. An arterial gas analysis will be performed after 20 minutes. Infants with normal gas-exchange are gradually weaned from mechanical ventilation At each weaning step an arterial hemogasanalysis is performed after 20 minutes, to assess if the decreased ventilatory support is tolerated. Increased work of breathing and respiratory acidosis (ph< 7.3 or pCO2 > 60 mmHg) are considered criteria to withhold the weaning process. After a 4 hour period on SIMV+PSV the child should be switched to PSV for 30 minutes and then extubated. The following extubation criteria should be reached:

  • Satisfactory blood gases with PCO2 under 45mmHg, pH greater than 7.30.
  • Fractional inspired oxygen concentration of 65% and or less than the baseline value
  • Adequate respiratory frequency according to age without dyspnea

At this point criteria for extubation are reached. Once extubation has taken place the child will be placed either on traditional oxygen therapy or high flow nasal cannulae according to randomization.

Undersøgelsestype

Interventionel

Tilmelding (Forventet)

80

Fase

  • Ikke anvendelig

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

  • Italien
      • Rome, Italien, 00165
        • Rekruttering
        • Ospedale Bambino Gesu
        • Kontakt:
        • Ledende efterforsker:
          • Francesca Iodice, M.D.
      • Rome, Italien, 00195
        • Rekruttering
        • Francesca Iodice
        • Kontakt:
        • Kontakt:
        • Underforsker:
          • Giuseppina Testa, MD
        • Underforsker:
          • Vincenzo Vitale, MD

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

1 dag til 1 år (Barn)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  • Age: 0-18 months
  • Mechanical Ventilation via an endotracheal tube
  • Elective surgery
  • Post-bypass procedure
  • Rachs 2 and above

Exclusion Criteria:

  • Presence of major congenital malformations
  • Presence of neuromuscular disease
  • Presence of non drained pneumothorax
  • Absent respiratory drive or recurrent apneas
  • Hemodynamic instability
  • Glasgow coma score (GCS) less than 8
  • ECG with evidence of ischaemia or arrhythmias
  • Active bleeding

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Andet: High flows
Enhed: Use of high flows versus oxygen therapy
Once extubation has taken place the child will be placed either on traditional oxygen therapy or high flow nasal cannulae according to randomization.
Andre navne:
  • high flow nasal cannulae
  • (via Neonatal Nasal Cannula- Fisher & Paykel)
Enhed: oxygen therapy
Once extubation has taken place the child will be placed either on traditional oxygen therapy or high flow nasal cannulae according to randomization.
Andre navne:
  • traditional nasal cannulae
Andet: oxygen therapy
Enhed: oxygen therapy
Once extubation has taken place the child will be placed either on traditional oxygen therapy or high flow nasal cannulae according to randomization.
Andre navne:
  • traditional nasal cannulae

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Tidsramme
The primary aim of this study is to show an improvement of the average levels of postextubation PaCO2 in infants less than 18 months of age and post-bypass surgery
Tidsramme: Final outcome measure is assessed when 80 patients have been recruited.Outcome measure is assessed at the end of 48 hours postextubation and when the patient is discharged from the ICU.
Final outcome measure is assessed when 80 patients have been recruited.Outcome measure is assessed at the end of 48 hours postextubation and when the patient is discharged from the ICU.

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
The secondary aim is to verify the reintubation rate between the two groups.
Tidsramme: Final outcome measure is assessed when 80 patients have been recruited.Outcome measure is assessed at the end of 48 hours postextubation and when the patient is discharged from the ICU.
Other points that will be evaluated are: the improvement of X-ray findings, the length of ICU stay and the development of complications such as nasal ulcers and gastric distension.
Final outcome measure is assessed when 80 patients have been recruited.Outcome measure is assessed at the end of 48 hours postextubation and when the patient is discharged from the ICU.

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Bambino Gesù Hospital and Research Institute

Efterforskere

  • Ledende efterforsker: Francesca Iodice, MD, Ospedale Bambino Gesu'

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Generelle publikationer

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart

1. august 2012

Primær færdiggørelse (Forventet)

1. december 2012

Studieafslutning (Forventet)

1. december 2012

Datoer for studieregistrering

Først indsendt

2. juni 2012

Først indsendt, der opfyldte QC-kriterier

2. juli 2012

Først opslået (Skøn)

4. juli 2012

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Skøn)

22. august 2012

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

21. august 2012

Sidst verificeret

1. august 2012

Mere information

Begreber relateret til denne undersøgelse

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • BambinoGHRI

Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .

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