In very preterm infants who are being extubated to nasal continuous positive airway pressure (CPAP), does a continuous positive airway pressure (CPAP) recruitment maneuvre post extubation improve global and regional end-expiratory lung volume, thoracoabdominal asynchrony and work of breathing when compared to no recruitment maneuvre?
- Conditions
- Respiratory Distress SyndromeRespiratory - Other respiratory disorders / diseases
- Registration Number
- ACTRN12610000167066
- Lead Sponsor
- Professor Peter Davis
- Brief Summary
Not available
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Recruiting
- Sex
- All
- Target Recruitment
- 50
Ventilated infants less than 32 weeks gestational age who are being extubated to nasal CPAP who have an inspired fraction of oxygen (FiO2) requirement < 0.4 to maintain saturations 88-92%
Infants will be excluded if they are at risk of being intubated secondary to increasing FiO2 requirements or have multiple episodes of apnoea requiring stimulation; are at risk of being intubated in the next 2-3 hours post-extubation; are receiving NIPPV (non-invasive positive pressure ventilation; have a major congenital anomaly that might have an adverse effect on breathing or ventilation, apart from prematurity or asphyxia; are too unstable for routine nursing and have skin that is too fragile for conventional ECG electrode placement
Study & Design
- Study Type
- Interventional
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Regional lung volume and tidal ventilation will be measured using GoeMF II Electrical Impedance Tomography (EIT) system (Cardinal Healthcare, Gottingen, Germany). Electrical Impedance Tomography is a non-invasive, radiation-free tool that allows real-time imaging of global and regional lung function and allows assessment of tidal ventilation on a breath-by-breath basis within different regions of the lung. It is based on the measurement of electrical voltages resulting from the injection of very small electrical currents continuously measured on the thoracic circumference using 16 conventional surface electrodes. The difference in the voltage between the transmitting and receiving current represents the impedance change and is proportional to change in lung volume.[Baseline (while intubated) then during extubation and then at 5, 20, 35, 50, 65, 80, 95 and 120mins from extubation and commencement of CPAP.]
- Secondary Outcome Measures
Name Time Method Changes in end-expiratory lung volume, tidal volume, thoraco-abdominal synchrony and work of breathing will be measured using Respiratory Inductive Plethysmography (RIP) (Non-invasive Monitoring systems Inc, Tampa, FL, USA). This involves placing 2 sinusoidal shielded wires embedded in elastic material (Respiband Plus, Sensor Medics, CA, USA) placed around the rib cage (at nipple level) and abdomen (at umbilical level). Oesophageal pressure (Poes) will be measured as a proxy for trans-pulmonary pressure. Poes will be measured using a balloon pressure transducer either embedded into a stand-alone 5FG or 6FG neonatal oesophageal catheter or a dual-function 7FG feeding tube/oesophageal catheter (Bicore, Cardinal Healthcare, Netherlands). Choice of catheter will depend on infant size.[Baseline (while intubated) then during extubation and then at 5, 20, 35, 50, 65, 80, 95 and 120mins from extubation and commencement of CPAP.]