Open Lung Maneuvers During High Frequency Oscillatory Ventilation in Preterm Infants

NCT ID: NCT04289324

Last Updated: 2024-11-20

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

36 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-02-25

Study Completion Date

2025-12-31

Brief Summary

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To assess whether stepwise oxygenation-guided lung recruitment at regular intervals reduces the oxygen saturation index (OSI = Mean Airway Pressure × Fraction of inspired Oxygen × 100 / peripheral Oxygen Saturation, OSI = MAPxFiO2x100/SpO2) averaged over high frequency oscillation ventilation (HFOV) time in extremely preterm infants.

Detailed Description

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Background: Open lung maneuvers aim to recruit and stabilize the majority of collapsed alveoli, using oxygenation as an indirect variable for lung volume. The stepwise oxygenation-guided lung recruitment procedure during frequency oscillatory ventilation (HFOV) in preterm infants has a low risk of lung hyperinflation and air leak syndrome. Nevertheless, open lung maneuvers at regular intervals during HFOV to maintain or restore oxygenation is not implemented as a routine procedure in the neonatal intensive care.

Aim of the study: To assess whether stepwise oxygenation-guided lung recruitment at regular intervals reduces the oxygen saturation index (OSI = Mean Airway Pressure × Fraction of inspired Oxygen × 100 / peripheral Oxygen Saturation, OSI = MAPxFiO2x100/SpO2) averaged over HFOV time in extremely preterm infants.

Study design: Single center randomized controlled study.

Methods: Thirty-six extremely preterm infants below 28 weeks of gestational age and on high frequency oscillation ventilation receive either stepwise oxygenation-guided lung recruitment maneuver at regular intervals (intervention) and upon decision of the care giving team (intervention group) or lung recruitment maneuver only upon decision of the care giving team (standard, control group). The primary outcome is the oxygen saturation index averaged over HFO ventilation time. The observation time of the HFOV will be limited to at most seven days.

Sample size: Fifteen infants need to be enrolled in each group to have 80% power (at a two-sided alpha level of 5%) to detect a difference of 25% in the oxygen saturation index between the intervention group and the control group.

Main outcome variables: Oxygen saturation index averaged over HFO ventilation time.

Secondary outcome variables: Bronchopulmonary dysplasia (BPD); days of ventilation; oxygen saturation index averaged over ventilation time (HFO and conventional ventilation); the following variables measured before, during and after a single stepwise oxygenation-guided recruitment maneuver: echocardiographic parameters, reactance, relative impedance changes, lung ultrasound measurements, transcutaneous partial carbon dioxide (CO2), blood pressure, heart rate.

Conditions

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High Frequency Oscillation Ventilation Extreme Prematurity Lung Injury, Acute

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Single center randomized controlled study
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Intervention

lung recruitment maneuvers performed every twelve hours during HFOV

Group Type EXPERIMENTAL

regular lung recruitment

Intervention Type PROCEDURE

stepwise oxygenation-guided lung recruitment at regular (twelve hours) intervals during high frequency oscillation ventilation

Control

no regular lung recruitment maneuvers during HFOV

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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regular lung recruitment

stepwise oxygenation-guided lung recruitment at regular (twelve hours) intervals during high frequency oscillation ventilation

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* born below 28 weeks of gestational age
* not older than 29 weeks of postmenstrual age
* receive HFOV

Exclusion Criteria

* known congenital anomalies of the heart, of the lung, and/or of the central nervous system
* known chromosomal abnormalities
* participation in other intervention trials
Maximum Eligible Age

8 Weeks

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Medical University of Vienna

OTHER

Sponsor Role lead

Responsible Party

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Tobias Werther

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Tobias Werther

Role: PRINCIPAL_INVESTIGATOR

Medical University of Vienna

Locations

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Medical University of Vienna

Vienna, Vienna, Austria

Site Status RECRUITING

Countries

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Austria

Central Contacts

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Tobias Werther

Role: CONTACT

+4314040032320

Facility Contacts

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Tobias Werther

Role: primary

014040032320

References

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Rimensberger PC, Pache JC, McKerlie C, Frndova H, Cox PN. Lung recruitment and lung volume maintenance: a strategy for improving oxygenation and preventing lung injury during both conventional mechanical ventilation and high-frequency oscillation. Intensive Care Med. 2000 Jun;26(6):745-55. doi: 10.1007/s001340051242.

Reference Type BACKGROUND
PMID: 10945393 (View on PubMed)

Rimensberger PC, Beghetti M, Hanquinet S, Berner M. First intention high-frequency oscillation with early lung volume optimization improves pulmonary outcome in very low birth weight infants with respiratory distress syndrome. Pediatrics. 2000 Jun;105(6):1202-8. doi: 10.1542/peds.105.6.1202.

Reference Type BACKGROUND
PMID: 10835058 (View on PubMed)

De Jaegere A, van Veenendaal MB, Michiels A, van Kaam AH. Lung recruitment using oxygenation during open lung high-frequency ventilation in preterm infants. Am J Respir Crit Care Med. 2006 Sep 15;174(6):639-45. doi: 10.1164/rccm.200603-351OC. Epub 2006 Jun 8.

Reference Type BACKGROUND
PMID: 16763218 (View on PubMed)

de Waal K, Evans N, van der Lee J, van Kaam A. Effect of lung recruitment on pulmonary, systemic, and ductal blood flow in preterm infants. J Pediatr. 2009 May;154(5):651-5. doi: 10.1016/j.jpeds.2009.01.012.

Reference Type BACKGROUND
PMID: 19364558 (View on PubMed)

Zannin E, Doni D, Ventura ML, Fedeli T, Rigotti C, Dellaca RL, Tagliabue PE. Relationship between Mean Airways Pressure, Lung Mechanics, and Right Ventricular Output during High-Frequency Oscillatory Ventilation in Infants. J Pediatr. 2017 Jan;180:110-115. doi: 10.1016/j.jpeds.2016.09.015. Epub 2016 Oct 10.

Reference Type BACKGROUND
PMID: 27745747 (View on PubMed)

Werther T, Kueng E, Aichhorn L, Pummer L, Goeral K, Berger A, Hermon M, Klebermass-Schrehof K. Regular lung recruitment maneuvers during high-frequency oscillatory ventilation in extremely preterm infants: a randomized controlled trial. BMC Pediatr. 2022 Dec 12;22(1):710. doi: 10.1186/s12887-022-03780-7.

Reference Type DERIVED
PMID: 36503480 (View on PubMed)

Other Identifiers

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1161/2019

Identifier Type: -

Identifier Source: org_study_id

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