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Nasal HFOV Versus Nasal CPAP to Reduce Post-extubation pCO2

21 juli 2020 uppdaterad av: Christoph Czernik, Charite University, Berlin, Germany

Nasal High Frequency Oscillation Ventilation Versus Nasal Continuous Positive Airway Pressure to Reduce Post-extubation pCO2 in Very Low Birth Weight Infants: a Randomized Controlled Trial

To investigate whether nasal high frequency oscillation ventilation (nHFOV) immediately after extubation reduces the arterial partial pressure of carbon dioxide (paCO2) at 72 hours after extubation in comparison with nasal continuous positive airway pressure (nCPAP) in very low birth weight infants (VLBWs).

Studieöversikt

Status

Avslutad

Betingelser

Intervention / Behandling

Detaljerad beskrivning

Randomized controlled clinical trial comparing nHFOV vs nCPAP immediately after extubation of VLBW infants.

Intervention and treatment protocol as described for the two study arms.

Definition of treatment failure (infant meets at least one criterion):

  • Sustained pCO2 >80 mmHg and pH <7.20 confirmed by arterial or capillary blood gas analysis in spite of optimized non-invasive respiratory support with maximum settings as defined above.
  • Fraction of inspired oxygen (FiO2) >0.6 to maintain peripheral oxygen saturation as measured by pulse oximetry (SpO2) at 90-94% in spite of optimized non-invasive respiratory support with maximum settings as defined above.
  • Reintubation (study patients may be intubated at any time, due to clinical considerations, with or without reaching another criterion of "treatment failure").

Sample size:

Assuming a variability of the paCO2 as previously reported for difficult-to-wean preterm infants in our unit (Czernik C, J Matern Fetal Neonatal Med 2012) and a treatment failure rate of 22% within 72 hours after extubation, we calculated a sample size of 34 patients in each study arm to detect a difference in the paCO2 of 7 mmHg, using a two-sided significance of 0.05 and a power of 0.8.

Randomization:

Sequence generation by an independent statistician and a study nurse. Block randomization using at least two different block sizes. Allocation concealment using sequentially numbered opaque sealed envelopes.

Data monitoring:

By an independent statistician.

Studietyp

Interventionell

Inskrivning (Faktisk)

6

Fas

  • Inte tillämpbar

Kontakter och platser

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Studieorter

  • Tyskland
      • Berlin, Tyskland
        • Dpt. of Neonatology, Charité - Universitätsmedizin Berlin

Deltagandekriterier

Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.

Urvalskriterier

Åldrar som är berättigade till studier

5 dagar till 4 veckor (Barn)

Tar emot friska volontärer

Nej

Kön som är behöriga för studier

Allt

Beskrivning

Inclusion Criteria:

  • Gestational age <32+0 weeks
  • Birth weight <1500 g
  • Received mechanical ventilation via an endotracheal tube for ≥120 h
  • Caffeine treatment according to unit guidelines
  • paCO2 <65 mmHg with pH >7.2
  • FiO2 25-40% to maintain SpO2 at 90-94%.
  • Time-cycled, pressure-controlled ventilation: PIP ≤22 cm H2O, PEEP ≤6 cm H2O; Volume guarantee ventilation: Working Ppeak ≤22 cm H2O, PEEP ≤6 cm H2O; High frequency oscillation ventilation: Pmean ≤12 cm H2O, Amplitude ≤30 cm H2O
  • Decision of the attending clinician to extubate

Exclusion Criteria:

  • Major congenital malformation requiring surgery
  • Duct-dependent congenital heart disease
  • Neuromuscular disease
  • Participation in another randomized controlled trial
  • Death before reaching the eligibility criteria
  • Hydrocortisone treatment at the time of enrolment
  • Chronological age >28 days

Studieplan

Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.

Hur är studien utformad?

Designdetaljer

  • Primärt syfte: Behandling
  • Tilldelning: Randomiserad
  • Interventionsmodell: Parallellt uppdrag
  • Maskning: Ingen (Open Label)

Vapen och interventioner

Deltagargrupp / Arm
Intervention / Behandling
Experimentell: nHFOV

Immediately after extubation, nHFOV is provided via binasal prongs. Ventilator settings: Frequency set at 10 Hz, I:E ratio 33:66, amplitude 20 cm H2O, Pmean 8 cm H2O, flow 7 l/min. Set FiO2 to maintain SpO2 at 90-94%.

The weaning process is left to the discretion of the attending physician. Maximum amplitude 30 cm H2O, minimum frequency 9 Hz, maximum Pmean 8 cm H2O.

For infants in the nHFOV-group who "fail" nHFOV (see definition below), but do not need immediate reintubation, a non-invasive "Rescue-Treatment" may be provided. The decision to attempt "Rescue-Treatment", the mode of respiratory support and the ventilator settings used are at the discretion of the attending clinician.
Enhet: nHFOV
Extubation to ventilator-derived nHFOV using binasal prongs
Aktiv komparator: nCPAP

Immediately after extubation, nCPAP is provided via binasal prongs. Ventilator settings: CPAP level set at 8 cm H2O, flow 7 l/min. Set FiO2 to maintain SpO2 at 90-94%.

The weaning process is left to the discretion of the attending physician. Maximum CPAP level 8 cm H2O, maximum flow 8 l/min.

For infants in the nCPAP-group who "fail" nCPAP (see definition below), but do not need immediate reintubation, "Rescue-nHFOV" via binasal prongs may be provided. The decision to attempt "Rescue-nHFOV" and the ventilator settings used are at the discretion of the attending clinician.
Enhet: nCPAP
Extubation to ventilator-derived nCPAP using binasal prongs

Vad mäter studien?

Primära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
paCO2 at 72 h After Extubation
Tidsram: 64 h to 80 h
Partial pressure of arterial carbon dioxide assessed between 64 and 80 hours, and on average 72 hours.
64 h to 80 h

Sekundära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
pH at 2 h After Extubation
Tidsram: within the first 6 h after extubation
within the first 6 h after extubation
paO2 at 2 h After Extubation
Tidsram: within the first 6 h after extubation
within the first 6 h after extubation
paCO2 at 2 h After Extubation
Tidsram: within the first 6 h after extubation
within the first 6 h after extubation
Base Excess at 2 h After Extubation
Tidsram: within the first 6 h after extubation
within the first 6 h after extubation
pH at 72 h After Extubation
Tidsram: 64-80 h after extubation
64-80 h after extubation
paO2 at 72 h After Extubation
Tidsram: 64-80 h after extubation
64-80 h after extubation
Base Excess at 72 h After Extubation
Tidsram: 64-80 h after extubation
64-80 h after extubation
Successful Extubation
Tidsram: 72 h after extubation
Defined as the number of patients breathing spontaneously in their assigned treatment group for ≥72h without reaching the criterion of "treatment failure"
72 h after extubation
Treatment Failure
Tidsram: within 7 days after extubation
Defined as the number of patients reaching the criterion of "treatment failure"
within 7 days after extubation
Reintubation
Tidsram: within 7 days after extubation
Defined as the number of patients being reintubated
within 7 days after extubation
Highly Viscous Secretions
Tidsram: within 72 hours after extubation
Defined as the documented number of episodes of airway obstruction due to highly viscous secretions per patient
within 72 hours after extubation
Other Adverse Effects
Tidsram: until discharge
Incidences of the following adverse effects: Intraventricular hemorrhage III°-IV° (Papile), surgical necrotizing enterocolitis, pneumothorax, pulmonary interstitial emphysema, persistent ductus arteriosus requiring surgical closure, retinopathy of prematurity requiring laser treatment and/or injection of bevacizumab, death or moderate to severe bronchopulmonary dysplasia (Jobe) at 36 weeks' gestational age, periventricular leukomalacia
until discharge
Duration of Respiratory Support
Tidsram: until discharge
Total duration of mechanical ventilation, total duration of supplemental oxygen, number of infants discharged with home oxygen
until discharge

Andra resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
pH at 2 h After Switch to "Rescue Treatment"
Tidsram: within the first 6 h after switch to "rescue treatment"
within the first 6 h after switch to "rescue treatment"
paO2 at 2 h After Switch to "Rescue Treatment"
Tidsram: within the first 6 h after switch to "rescue treatment"
within the first 6 h after switch to "rescue treatment"
paCO2 at 2 h After Switch to "Rescue Treatment"
Tidsram: within the first 6 h after switch to "rescue treatment"
within the first 6 h after switch to "rescue treatment"
Base Excess at 2 h After Switch to "Rescue Treatment"
Tidsram: within the first 6 h after switch to "rescue treatment"
within the first 6 h after switch to "rescue treatment"
Successful Rescue
Tidsram: 72 h after switch to "rescue" treatment
Defined as spontaneous breathing for ≥72h after starting "rescue" therapy, without reaching the criterion of "treatment failure"
72 h after switch to "rescue" treatment

Samarbetspartners och utredare

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Sponsor

Charite University, Berlin, Germany

Utredare

  • Huvudutredare: Christoph Czernik, MD PhD, Charite University, Berlin, Germany

Publikationer och användbara länkar

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Allmänna publikationer

Studieavstämningsdatum

Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.

Studera stora datum

Studiestart (Faktisk)

1 januari 2015

Primärt slutförande (Faktisk)

31 december 2017

Avslutad studie (Faktisk)

31 december 2017

Studieregistreringsdatum

Först inskickad

10 januari 2015

Först inskickad som uppfyllde QC-kriterierna

13 januari 2015

Första postat (Uppskatta)

16 januari 2015

Uppdateringar av studier

Senaste uppdatering publicerad (Faktisk)

5 augusti 2020

Senaste inskickade uppdateringen som uppfyllde QC-kriterierna

21 juli 2020

Senast verifierad

1 juli 2020

Mer information

Termer relaterade till denna studie

Nyckelord

Ytterligare relevanta MeSH-villkor

Andra studie-ID-nummer

  • EA2/011/12

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