Respiratory Distress SyndromeNCT02030652
Impact of Synchronized Nasal Intermittent Positive Pressure Ventilation Using NAVA in Preterm Infants With RDS
A study testing Intermittent nasal positive pressure positive ventilation. and CPAP in people with Respiratory Distress Syndrome, run by Hospital Israelita Albert Einstein at 1 site in Brazil.
Trial summary
The nasal CPAP (continuous positive airway pressure), is a technique of noninvasive ventilation commonly used in neonatal intensive care units, and has recently been used in association with nasal intermittent mandatory ventilation (NIPPV - intermittent Nasal Positive Pressure Ventilation), which consists of the… Read more about this study
- Who is it for?
- Ages 23 to 36 weeks
- Conditions the study is for
- Respiratory Distress Syndrome
- What is being tested?
- Intermittent nasal positive pressure positive ventilation. and CPAP
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 56 participants
- Where
- 1 siteBrazil
- Study dates
- Jan 2014to Dec 2015
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 23 to 36 weeks
- All sexes
- No healthy volunteers
- Child
Who may be able to join
- Will be included in study preterm infants with respiratory failure and indication of noninvasive ventilatory support, characterized by clinical evidence of respiratory failure requiring use of oxygen greater than or equal to a FiO2 0.25.
Who cannot join
- Will be excluded from the study infants that parents did not agree on participation; diagnosed with major congenital anomalies; with necessity of chest drainage; diagnosis of intracranial hemorrhage grades III and IV according to the criteria of Papile et al; persistence ductus arteriosus with hemodynamic consequences and diagnosis of severe perinatal asphyxia - defined as less than 6 APGAR with 5 minutes of life.
Trial locations and contacts
1 site in 1 country.
Brazil1 site, 1 recruiting
- Recruiting
Hospital Israelita Albert Einstein
São Paulo, São Paulo, 05652-000
Celso M Rebello, MD PhD, 55-11-983922041, celsomr@einstein.br
Ana cristina Z Yagui, RT, 55-11-983619730, anac.yagui@gmail.com
About this study
Official title: Impact of Synchronized Nasal Intermittent Positive Pressure Ventilation Using Non Invasive Neurally Adjusted Ventilatory Assist (NAVA) in Preterm Infants With Respiratory Distress
The nasal CPAP (continuous positive airway pressure), is a technique of noninvasive ventilation commonly used in neonatal intensive care units, and has recently been used in association with nasal intermittent mandatory ventilation (NIPPV - intermittent Nasal Positive Pressure Ventilation), which consists of the application of respiratory positive pressure cycles during the application of nasal CPAP, resulting in high pharyngeal pressures. The NIPPV has advantages over traditional CPAP, including the prevention of atelectasis, improved respiratory mechanics and decreased work of breathing in premature infants. A refinement of this technique is the use of positive pressure breaths associated with nasal CPAP synchronously in relation to the newborn's inspiratory effort (SNIPPV - Synchronized Nasal Positive Pressure Ventilation).
Synchronization allows that the cycles of inspiratory positive pressure provided by the ventilator coincide with the inspiratory effort, increasing the system efficacy. The Neurally Adjusted Ventilatory Assist (NAVA) is a mode of partial ventilatory support based on the use of electrical activity of the diaphragm (Edi) to control the mechanical ventilator. The ventilatory assistance starts according to respiratory needs of the patient, its use in very low birth weight infants showed an improvement in patient-ventilator interaction, even in the presence of leak around the endotracheal tube. This prospective randomized, clinical trial aims to evaluate, in preterm infants with gestational age lower than 34 weeks with respiratory failure treated with noninvasive ventilatory support, the impact of SNIPPV with neural adjustment (NAVA) on success ventilation and the need for endotracheal intubation when compared to treatment with traditional CPAP.
Read the detailed description
Type and location of the study A prospective , randomized , open label clinical study will be conducted at the Albert Einstein Jewish Hospital Neonatal ICU, after approval by the Ethics Committee and the Research Institute of Education and Research. To participate in the study the parents or legal guardians must complete and sign the Statement of Consent.
Randomization and formation of study groups Two study groups will be formed according to the type of non- invasive ventilatory support: SNIPPV Group (synchronized nasal intermittent positive pressure) and CPAP group (continuous positive airway pressure). The formation of study groups will be by randomization through opaque envelopes containing in its interior the type of treatment to be used. The envelopes will be opened at the initiation of treatment.
Inclusion Criteria Will be included in study preterm infants with respiratory failure and indication of noninvasive ventilatory support, characterized by clinical evidence of respiratory failure requiring use of oxygen greater than or equal to a FiO2 0.25.
Exclusion Criteria Will be excluded from the study infants that parents did not agree on participation; diagnosed with major congenital anomalies; with necessity of chest drainage; diagnosis of intracranial hemorrhage grades III and IV according to the criteria of Papile et al; persistence ductus arteriosus with hemodynamic consequences and diagnosis of severe perinatal asphyxia - defined as less than 6 APGAR with 5 minutes of life.
Definition of the primary variable and secondary variables:
Demographic data regarding to birth weight, gestational age, sex, Apgar scores (1 and 5 minutes), type of delivery, use of antenatal corticosteroids, magnesium sulfate, multiple births, maternal diseases will be collected.
The main variable will be the need for endotracheal intubation. This will be defined as the need to use the fraction of inspired oxygen (FiO2) greater than 0.30 and 7 cmH2O or more of CPAP pressure for maintaining a target oxygen saturation of 88-94 % for preterm infants with gestational age less or equal to 27 6/7 weeks, or a FiO2 higher than 0.35 and 7 cmH2O or more of CPAP pressure for maintaining a target oxygen saturation of 88-94 % for preterm infants with gestational age higher or equal to 28 0/7 weeks gestation.
Secondary variables will be defined as the total time of nCPAP , the total time of oxygen use; time for the indication of invasive mechanical ventilation, the incidence of pneumothorax and the maximum values of FiO2 in noninvasive support, the average values of CPAP pressure, the incidence of bronchopulmonary dysplasia (defined as oxygen requirement at 36 weeks corrected gestational age), the incidence of intracranial hemorrhage and intracranial hemorrhage grades III and IV according to Papile et al.
Ventilatory strategies The equipment used for both ventilation modes will be the Servo i (Maquet , Getinge Group , Solna , Sweden). The pressure initially applied will be CPAP 5 cmH2O in both groups and can be increased up to 7 cm H2O at the discretion of the attending physician. The CPAP applied and FiO2 will be adjusted toward maintenance of oxygen saturation target of 88-94 % .
Statistical analysis and sample size. Comparisons between continuous variables will be performed by "t " Student test . The Kruskal - Wallys be used for non-parametric data . Categorical variables were compared using the chi -square or Fisher's exact test , as appropriate. The level of significance adopted will be 0.05.
- Conditions
- Respiratory Distress Syndrome
- Being tested
- Intermittent nasal positive pressure positive ventilation., CPAP
- Keywords
- premature newborn, nasal ventilation, noninvasive ventilation, continuous positive airway pressure
- Medical subject headings
- Respiratory Distress Syndrome, Premature Birth
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Intermittent nasal positive pressure positive ventilation.Procedure or surgery
CPAPProcedure or surgery
Nasal continuous positive airway pressure
| Study group | Role | What they receive |
|---|---|---|
| SNIPPV Group | Experimental | Synchronized nasal intermittent positive pressure using NAVA ( Intermittent nasal positive pressure positive ventilation.) Receives: Procedure: Intermittent nasal positive pressure positive ventilation. |
| CPAP Group | Active comparator | Nasal CPAP group without intermittent ventilation. Receives: Procedure: CPAP |
What is being measured
The primary outcome is the main question the study is designed to answer.
Need for endotracheal intubation
Necessity of intubation and mechanical ventilation until the end of the first week of life.
Measured: 7 days
Secondary outcomes (1)
Total time of nCPAP
Total time of nCPAP use.
Measured: 1 month
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted8 Jan 2014 (estimated)
- Study startJan 2014
- Primary completionNov 2015 (estimated)
- Study completionDec 2015 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Respiratory Distress SyndromeStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 56 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Hospital Israelita Albert Einstein
- Sponsor type
- University, hospital or other
- Collaborators
- Fundação de Amparo à Pesquisa do Estado de São Paulo
- Responsible party
- Principal investigator, Celso Rebello MD, Hospital Israelita Albert Einstein
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02030652
- Sponsor's protocol ID
- HIAE-2013-001
- Other IDs
- 2013/12499-0
- Status last verified
- Aug 2015
- First submitted
- 7 Jan 2014
- Last updated
- 19 Aug 2015
- Results posted
- No
- Data monitoring committee
- No
Study at a glance
From the registry record, last updated by the sponsor on 19 Aug 2015. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Impact of Synchronized Nasal Intermittent Positive Pressure Ventilation Using Non Invasive Neurally Adjusted Ventilatory Assist (NAVA) in Preterm Infants With Respiratory Distress
- ClinicalTrials.gov ID
- NCT02030652
- Acronym / sponsor ID
- HIAE-2013-001
- Conditions
- Respiratory Distress Syndrome
- Keywords
- premature newborn, nasal ventilation, noninvasive ventilation, continuous positive airway pressure
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 56 participants (estimated)
- Lead sponsor
- Hospital Israelita Albert EinsteinUniversity, hospital or other
- Collaborators
- Fundação de Amparo à Pesquisa do Estado de São Paulo
- Study start
- Jan 2014
- Primary completion
- Nov 2015 (estimated)
- Study completion
- Dec 2015 (estimated)
- First posted
- 8 Jan 2014 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The nasal CPAP (continuous positive airway pressure), is a technique of noninvasive ventilation commonly used in neonatal intensive care units, and has recently been used in association with nasal intermittent mandatory ventilation (NIPPV - intermittent Nasal Positive Pressure Ventilation), which consists of the application of respiratory positive pressure cycles during the application of nasal CPAP, resulting in high pharyngeal pressures. The NIPPV has advantages over traditional CPAP, including the prevention of atelectasis, improved respiratory mechanics and decreased work of breathing in premature infants. A refinement of this technique is the use of positive pressure breaths associated with nasal CPAP synchronously in relation to the newborn's inspiratory effort (SNIPPV - Synchronized Nasal Positive Pressure Ventilation).
Synchronization allows that the cycles of inspiratory positive pressure provided by the ventilator coincide with the inspiratory effort, increasing the system efficacy. The Neurally Adjusted Ventilatory Assist (NAVA) is a mode of partial ventilatory support based on the use of electrical activity of the diaphragm (Edi) to control the mechanical ventilator. The ventilatory assistance starts according to respiratory needs of the patient, its use in very low birth weight infants showed an improvement in patient-ventilator interaction, even in the presence of leak around the endotracheal tube. This prospective randomized, clinical trial aims to evaluate, in preterm infants with gestational age lower than 34 weeks with respiratory failure treated with noninvasive ventilatory support, the impact of SNIPPV with neural adjustment (NAVA) on success ventilation and the need for endotracheal intubation when compared to treatment with traditional CPAP.
Detailed description
Type and location of the study A prospective , randomized , open label clinical study will be conducted at the Albert Einstein Jewish Hospital Neonatal ICU, after approval by the Ethics Committee and the Research Institute of Education and Research. To participate in the study the parents or legal guardians must complete and sign the Statement of Consent.
Randomization and formation of study groups Two study groups will be formed according to the type of non- invasive ventilatory support: SNIPPV Group (synchronized nasal intermittent positive pressure) and CPAP group (continuous positive airway pressure). The formation of study groups will be by randomization through opaque envelopes containing in its interior the type of treatment to be used. The envelopes will be opened at the initiation of treatment.
Inclusion Criteria Will be included in study preterm infants with respiratory failure and indication of noninvasive ventilatory support, characterized by clinical evidence of respiratory failure requiring use of oxygen greater than or equal to a FiO2 0.25.
Exclusion Criteria Will be excluded from the study infants that parents did not agree on participation; diagnosed with major congenital anomalies; with necessity of chest drainage; diagnosis of intracranial hemorrhage grades III and IV according to the criteria of Papile et al; persistence ductus arteriosus with hemodynamic consequences and diagnosis of severe perinatal asphyxia - defined as less than 6 APGAR with 5 minutes of life.
Definition of the primary variable and secondary variables:
Demographic data regarding to birth weight, gestational age, sex, Apgar scores (1 and 5 minutes), type of delivery, use of antenatal corticosteroids, magnesium sulfate, multiple births, maternal diseases will be collected.
The main variable will be the need for endotracheal intubation. This will be defined as the need to use the fraction of inspired oxygen (FiO2) greater than 0.30 and 7 cmH2O or more of CPAP pressure for maintaining a target oxygen saturation of 88-94 % for preterm infants with gestational age less or equal to 27 6/7 weeks, or a FiO2 higher than 0.35 and 7 cmH2O or more of CPAP pressure for maintaining a target oxygen saturation of 88-94 % for preterm infants with gestational age higher or equal to 28 0/7 weeks gestation.
Secondary variables will be defined as the total time of nCPAP , the total time of oxygen use; time for the indication of invasive mechanical ventilation, the incidence of pneumothorax and the maximum values of FiO2 in noninvasive support, the average values of CPAP pressure, the incidence of bronchopulmonary dysplasia (defined as oxygen requirement at 36 weeks corrected gestational age), the incidence of intracranial hemorrhage and intracranial hemorrhage grades III and IV according to Papile et al.
Ventilatory strategies The equipment used for both ventilation modes will be the Servo i (Maquet , Getinge Group , Solna , Sweden). The pressure initially applied will be CPAP 5 cmH2O in both groups and can be increased up to 7 cm H2O at the discretion of the attending physician. The CPAP applied and FiO2 will be adjusted toward maintenance of oxygen saturation target of 88-94 % .
Statistical analysis and sample size. Comparisons between continuous variables will be performed by "t " Student test . The Kruskal - Wallys be used for non-parametric data . Categorical variables were compared using the chi -square or Fisher's exact test , as appropriate. The level of significance adopted will be 0.05.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| SNIPPV Group | Experimental | Procedure: Intermittent nasal positive pressure positive ventilation.Synchronized nasal intermittent positive pressure using NAVA ( Intermittent nasal positive pressure positive ventilation.) |
| CPAP Group | Active comparator | Procedure: CPAPNasal CPAP group without intermittent ventilation. |
Who may qualify
- Ages
- 23 to 36 weeks
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child
Key inclusion criteria (1 listed)
- Will be included in study preterm infants with respiratory failure and indication of noninvasive ventilatory support, characterized by clinical evidence of respiratory failure requiring use of oxygen greater than or equal to a FiO2 0.25.
Key exclusion criteria (1 listed)
- Will be excluded from the study infants that parents did not agree on participation; diagnosed with major congenital anomalies; with necessity of chest drainage; diagnosis of intracranial hemorrhage grades III and IV according to the criteria of Papile et al; persistence ductus arteriosus with hemodynamic consequences and diagnosis of severe perinatal asphyxia - defined as less than 6 APGAR with 5 minutes of life.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Intermittent nasal positive pressure positive ventilation. | Procedure or surgery | SNIPPV Group |
| CPAPNasal continuous positive airway pressure | Procedure or surgery | CPAP Group |
Primary outcome
Need for endotracheal intubation
Time frame: 7 days
Necessity of intubation and mechanical ventilation until the end of the first week of life.
1 secondary outcome
Total time of nCPAP
Time frame: 1 month
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 19 Aug 2015.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Intermittent nasal positive pressure positive ventilation. and CPAP in people with Respiratory Distress Syndrome, run by Hospital Israelita Albert Einstein at 1 site in Brazil.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 19 Aug 2015. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Brazil. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Each site lists its own contact: choose the nearest one under Trial locations. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Need for endotracheal intubation (time frame: 7 days). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Aug 2015.