Respiratory Distress Syndrome in Premature Infants Clinical Trial
Official title:
Study of Nasopharyngeal Pressures, Tidal Breathing Indices and Inspired Gas Concentrations During High Flow Nasal Cannula (HFNC) and CPAP Treatment in Neonates
The most commonly used noninvasive respiratory support in preterm babies is Continuous
Positive Airway Pressure (CPAP), which provides extra breathing support to babies who are
breathing by themselves). Increasingly High flow Nasal Cannula (HFNC, newer form of extra
breathing support) therapy has found its way in clinical practice despite lack of good
physiological data. There are also concerns about its potential to generate higher pressures
in airways which can cause over distension of lungs.
We would like to find out the effects of HFNC on
- 1. Airway pressures in various flow rates and in comparison to CPAP.
- 2. Breathing markers including respiratory rate (speed of breathing), oxygen and carbon
dioxide levels, tidal volumes (how much air breathed in with each breath) and airway
wash out (wash out of waste gas from the airway).
We plan to study 15 babies each in three different weight categories supported with either
CPAP or HFNC. The airway pressures, oxygen and carbon dioxide concentration in airway are
measured by a small plastic catheter (similar to feeding tube but much shorter in length),
carbon dioxide levels by skin sensors, how fast and how much babies breathe by a special
vest applied like a layer of clothing. These will be recorded both on HFNC and CPAP. There
are no blood tests or invasive procedures involved. The baby will be monitored throughout
the study period of approximately two hours by experienced registrar who is trained to use
the study device.
This study will improve our understanding of physiological effects of HFNC and lead to
better care of preterm babies.
Purpose and design
Design: Prospective randomised crossover study.
Purpose:
- Raising airway pressure is one of the most important interventions at the disposal of
clinicians treating patients with respiratory failure. In premature infants Continuous
Positive Airway Pressure (CPAP) and High Flow Nasal Cannula (HFNC) are noninvasive
techniques to raise mean airway pressure when intubation is not required. It is not
clear how clinicians choose between these techniques and there is little data comparing
the physiological effect of these treatments.
- A composite physiological assessment of babies on HFNC and CPAP treatment is required
to understand how HFNC works. It is important to answer this question to understand how
best to use HFNC in babies.
- This proposal is designed to provide information on physiological effects of both
therapies in same population of babies across different weight categories. The study
protocol involves use of same HFNC device that is currently being used in neonatal
unit.
Interventions:
1. A small plastic catheter tip transducer (Gaeltec) will be placed in upper breathing
passage (nasopharynx or oropharynx) using standard methods. From this we will measure airway
pressures and respiratory gas concentrations.
The catheter will be removed soon after the study is completed. This procedure will be done
once during the study.
2. Breathing markers (Tidal breathing indices) will be measured by non invasive method using
Volusense method where a vest will be applied over the chest and abdomen like a layer of
clothing. The Volusense vest will be removed soon after the procedure. This process is done
once during the study.
3. Blood carbon dioxide (CO2) levels will be measured by a non invasive transcutaneous
sensor applied to the skin (Tosca Radiometer). This skin sensor will be removed soon after
the study is completed.
1. The baby must be clinically stable for preceding 12 hours on noninvasive breathing
support (not meeting exit criteria). The babies will be randomised to either group 1
(CPAP first followed by HFNC) or group 2 (HFNC first followed by CPAP) by computerised
software programme.
2. The measuring devices namely nasopharyngeal catheter, Volusense vest and transcutaneous
CO2 sensor are placed as per standard methods.
3. After ensuring babies' clinical stability the measurements are recorded at HFNC gas
flow rate range from 2 litres to 8 litres per minute and in CPAP of 6 cm of water
pressure level.
4. The study lasts about 2 hours. The baby spends 10 minutes at each HFNC flow rate level
and 30 minutes of equilibration period when support will be changed between HFNC and
CPAP.
5. Routine measurement of heart rate, respiratory rate and oxygen saturations will be done
as per standard neonatal practice. The above data will be recorded electronically for
analysis with total study duration around 120 minutes.
6. Respiratory support can be terminated at any point if clinically not indicated.
The researcher is an experienced neonatal registrar who will be directly observing the baby
throughout the study.
Measurements would be discontinued if any pre set exit criteria is noted.
Statistics: A total of 45 babies (15 babies in each weight category: <1000 grams, 1001500
grams and >1500 grams) will be studied.
;
Allocation: Randomized, Intervention Model: Crossover Assignment, Masking: Open Label, Primary Purpose: Basic Science
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