Effect of Nasal Continuous Positive Airway Pressure (nCPAP) Versus Non-Invasive Positive Pressure Ventilation (NIPPV) On Diaphragm Electrical Activity (Edi) In Very Low Birth Weight (VLBW) Preterm Infants
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 24
- 试验地点
- 2
- 主要终点
- The differences in Electrical Activity of the Diaphragm measured in MicroVoltage (Edi minimum) between: 1. Traditional CPAP versus NIPPV. 2. NIPPV versus CPAP (equivalent pressures in cmH2O).
研究概览
简要总结
Background:
In premature babies, many organ systems are not fully grown and developed, including the lungs and respiratory muscles, so they will need breathing support to help them to breathe by preventing their tiny air sacs to collapse. This support commonly done by CPAP and Non-Invasive Positive Pressure Ventilation (NIPPV) therapy by giving some pressure and oxygen to their lungs through an interface placed on their noses. Both (CPAP and NIPPV) can be used as a support modality for respiratory distress syndrome, apnea of prematurity, and providing breathing support after extubation from the full mechanical breathing support.
The CPAP supports the baby's immature lungs by delivering constant pressure to keep their lungs and breathing well supported. Whereas the NIPPV will use constant pressure in the background (similar to CPAP), and on top, it will give extra intermittent puffs at regular intervals to support the baby's breathing. The NIPPV is the most common choice by the clinicians when the traditional CPAP is no longer effective, to avoid the full mechanical breathing support and to protect the developing lungs.
Studies suggested that NIPPV is better than the traditional CPAP in reducing the need of the baby to need full mechanical breathing support. This might be because the investigators tend to use lower pressures with CPAP (5-8 cmH2O) compared to relatively higher pressures with NIPPV. More recently, clinicians showed the safety of using equivalent higher CPAP pressures (>9 cmH2O) to what the investigators use in the NIPPV in preterm babies.
One way to measure the support that the investigators are giving to the patient with the different devices is to measure the diaphragm activity, which the investigators call the Edi signal, using a special feeding catheter and a specific machine to measure it. The catheter is placed and used as a routine feeding tube but has sensors at the end to measure this Edi signal. One opening of the tube will be connected to a computer to record the Edi signals. The other opening of the tube will be used for feeding.
详细描述
Our main goal in this study:
To measure and compare the Edi in preterm babies requiring breathing support with CPAP or NIPPV.
Inclusion Criteria (Potential Candidates):
This study involves stable babies who were born with a birth weight of less than 1500 grams and require CPAP.
The steps of the study:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Crossover
- 主要目的
- Supportive Care
- 盲法
- None
入排标准
- 年龄范围
- 1 Day 至 8 Months（Child）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Clinically stable preterm infants (defined as cardiovascular stability with normal blood pressure and heart rate for gestational age and no recent increase in apneic episodes or spells and confirmed by the attending neonatologist)
- •Birth weight less than 1500 grams
- •Admitted to the NICU at Sunnybrook Health Sciences Centre on nasal CPAP of 5 to 8 cmH2O support, for at least 48 hours and requiring less than 35% of oxygen
排除标准
- •Congenital anomalies of the gastrointestinal tract
- •Phrenic nerve damage
- •Diaphragmatic paralysis
- •Esophageal perforation
- •Congenital or acquired neurological deficit (including significant intraventricular hemorrhage greater than Grade II) or neonatal seizure
- •Significant congenital heart disease (including symptomatic PDA)
- •Congenital anomalies of the diaphragm
- •Congenital anomalies of the respiratory tracts (e.g., Congenital Cystic Adenomatoid Malformation 'CCAM')
- •Ongoing treatment for sepsis
- •Ongoing treatment for necrotizing enterocolitis (NEC)
- •Ongoing treatment for lung infections
- •Narcotic analgesics
- •Gastric motility agents
- •Infants on nasal CPAP and requiring more than 35% oxygen
- •Infants with significant gastric residuals and vomiting
- •Infants with facial anomalies
- •Infants with pneumothorax or pneumomediastinum
- •Infants in the immediate postoperative period
研究组 & 干预措施
Traditional CPAP, then NIPPV, then high CPAP.
The participant will stay for 2 hours on Traditional CPAP, then 2 hours on NIPPV, then 2 hours on high CPAP. The investigators will continue to record the Edi signals during the 3 methods.
干预措施: Alternating traditional CPAP, NIPPV, and high CPAP (Other)
Traditional CPAP, then high CPAP, then NIPPV
The participant will stay for 2 hours on Traditional CPAP, then 2 hours on high CPAP, then 2 hours on NIPPV. The investigators will continue to record the Edi signals during the 3 methods.
干预措施: Alternating traditional CPAP, NIPPV, and high CPAP (Other)
NIPPV, then traditional CPAP, then high CPAP
The participant will stay for 2 hours on NIPPV, then 2 hours on traditional CPAP, then 2 hours on high CPAP. The investigators will continue to record the Edi signals during the 3 methods.
干预措施: Alternating traditional CPAP, NIPPV, and high CPAP (Other)
NIPPV, then high CPAP, then traditional CPAP.
The participant will stay for 2 hours on NIPPV, then 2 hours on high CPAP, then 2 hours on traditional CPAP. The investigators will continue to record the Edi signals during the 3 methods.
干预措施: Alternating traditional CPAP, NIPPV, and high CPAP (Other)
High CPAP, then traditional CPAP, then NIPPV.
The participant will stay for 2 hours on High CPAP, then 2 hours on traditional CPAP, then 2 hours on NIPPV. The investigators will continue to record the Edi signals during the 3 methods.
干预措施: Alternating traditional CPAP, NIPPV, and high CPAP (Other)
High CPAP, then NIPPV, then traditional CPAP.
The participant will stay for 2 hours on High CPAP, then 2 hours on NIPPV, then 2 hours on traditional CPAP. The investigators will continue to record the Edi signals during the 3 methods.
干预措施: Alternating traditional CPAP, NIPPV, and high CPAP (Other)
结局指标
主要结局
The differences in Electrical Activity of the Diaphragm measured in MicroVoltage (Edi minimum) between: 1. Traditional CPAP versus NIPPV. 2. NIPPV versus CPAP (equivalent pressures in cmH2O).
时间窗: 2 hours per each mode of ventilation, total of 6 hours Edi recording
次要结局
- 1. Neural respiratory rate per minute(2 hours per each mode of ventilation, total of 6 hours)
- 2. Edi peak measured in MicroVoltage(2 hours per each mode of ventilation, total of 6 hours)
- 3. The difference in transcutaneous pCO2 in mmHg(2 hours per each mode of ventilation, total of 6 hours)
- 4. The difference in oxygen requirements in percent (i.e, 21%)(2 hours per each mode of ventilation, total of 6 hours)