HFOV With Intermittent Sigh Breaths in Neonate: Carbon Dioxide Level

NCT ID: NCT05682937

Last Updated: 2025-02-21

Study Results

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

NA

Total Enrollment

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-01-12

Study Completion Date

2024-03-31

Brief Summary

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The goal of this clinical trial is to the short-term effects of sigh breaths during High-frequency oscillatory ventilation (HFOV) in neonate undergoing mechanical ventilation. From meta-analysis, It revealed HFOV in neonates could reduce chronic lung disease or death rather than conventional ventilation.

The main question it aims to answer is: Do sigh breaths augment restoring lung volume and ventilation (CO2 level) in intubated neonate with HFOV? Participants will be applied sigh breaths (HFOV-sigh) during on HFOV. Researchers will compare HFOV-sigh mode to see if CO2 level (before-after intervention).

Detailed Description

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Sample size calculation (before and after intervention: two dependent mean)

* alpha = 0.05, beta = 0.2,
* Delta = 1.9, SD. = 4.35
* Calculated sample size = 42
* increase sample size if loss follow up 20%
* Final sample size (n) = 50

Subgroup analysis for

* preterm neonates
* very preterm or very low birth weight neonates
* extremely preterm or extremely low birth weight neonates

Conditions

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High-Frequency Ventilation

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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HFOV-sigh mode

HFOV-sigh setting both brands of ventilator (SLE6000 and Drager Babylog VN500): setting (frequency \[Hz\], mean airway pressure \[MAP\], delta pressure \[dP\]) same as HFOV, set sigh RR 3 breath/min, Sigh inspiratory time \[Ti\] = 1 sec, Sigh peak inspiratory pressure \[PIP\] = (MAP+5, maximum 30) cm H2O, Slope sigh 0.5.

Group Type EXPERIMENTAL

HFOV-sigh

Intervention Type DEVICE

HFOV-sigh setting both SLE6000 and Drager Babylog VN500: setting (Hz, MAP, delta pressure) same as HFOV, set sigh RR 3 breath/min, Sigh Ti = 1 sec, Sigh PIP = (MAP+5, maximum 30) cm H2O, Slope sigh 0.5.

Interventions

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HFOV-sigh

HFOV-sigh setting both SLE6000 and Drager Babylog VN500: setting (Hz, MAP, delta pressure) same as HFOV, set sigh RR 3 breath/min, Sigh Ti = 1 sec, Sigh PIP = (MAP+5, maximum 30) cm H2O, Slope sigh 0.5.

Intervention Type DEVICE

Other Intervention Names

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HFOV-sigh application from both brands of ventilator (SLE6000 and Drager Babylog VN500)

Eligibility Criteria

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Inclusion Criteria

* Preterm and term neonate (gestational age 24-41 weeks) with postnatal age less than 28 days
* Already ventilated with high frequency ventilation at least 1 hours
* An umbilical or peripheral arterial catheterization was available

Exclusion Criteria

* Previous or current pulmonary air leaks (pulmonary interstitial emphysema, pneumothorax, pneumomediastinum, and pneumopericardium)
* Heterogeneous lung disease including MAS, congenital diaphragmatic hernia
* Suspected lung hypoplasia
* Suspected or confirmed intraventricular hemorrhage grade III-IV
* Suspected or confirmed hypoxic ischemic encephalopathy or 5-min Apgar score less than 3
* Hemodynamic instability despite using inotrope(s)
* Arterial pCO2 level less than 45 mm Hg or more than 70 mm Hg before intervention
* Need a new arterial puncture for samples both before and after interventions
* Moribund status
* Parents' decision not to participate
Minimum Eligible Age

1 Day

Maximum Eligible Age

28 Days

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Prince of Songkla University

OTHER

Sponsor Role lead

Responsible Party

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Anucha Thatrimontrichai

Office of Human Research Ethics Unit

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Anucha Thatrimontrichai, MD

Role: PRINCIPAL_INVESTIGATOR

Prince of Songkla University

Locations

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Songklanagarind Hospital, Prince of Songkla University

Hat Yai, Changwat Songkhla, Thailand

Site Status

Countries

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Thailand

References

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Cools F, Askie LM, Offringa M, Asselin JM, Calvert SA, Courtney SE, Dani C, Durand DJ, Gerstmann DR, Henderson-Smart DJ, Marlow N, Peacock JL, Pillow JJ, Soll RF, Thome UH, Truffert P, Schreiber MD, Van Reempts P, Vendettuoli V, Vento G; PreVILIG collaboration. Elective high-frequency oscillatory versus conventional ventilation in preterm infants: a systematic review and meta-analysis of individual patients' data. Lancet. 2010 Jun 12;375(9731):2082-91. doi: 10.1016/S0140-6736(10)60278-4.

Reference Type RESULT
PMID: 20552718 (View on PubMed)

Cools F, Offringa M, Askie LM. Elective high frequency oscillatory ventilation versus conventional ventilation for acute pulmonary dysfunction in preterm infants. Cochrane Database Syst Rev. 2015 Mar 19;2015(3):CD000104. doi: 10.1002/14651858.CD000104.pub4.

Reference Type RESULT
PMID: 25785789 (View on PubMed)

Courtney SE, Durand DJ, Asselin JM, Hudak ML, Aschner JL, Shoemaker CT; Neonatal Ventilation Study Group. High-frequency oscillatory ventilation versus conventional mechanical ventilation for very-low-birth-weight infants. N Engl J Med. 2002 Aug 29;347(9):643-52. doi: 10.1056/NEJMoa012750.

Reference Type RESULT
PMID: 12200551 (View on PubMed)

Hoch B, Bernhard M, Hinsch A. Different patterns of sighs in neonates and young infants. Biol Neonate. 1998;74(1):16-21. doi: 10.1159/000014006.

Reference Type RESULT
PMID: 9657665 (View on PubMed)

Jost K, Latzin P, Fouzas S, Proietti E, Delgado-Eckert EW, Frey U, Schulzke SM. Sigh-induced changes of breathing pattern in preterm infants. Physiol Rep. 2015 Nov;3(11):e12613. doi: 10.14814/phy2.12613.

Reference Type RESULT
PMID: 26564066 (View on PubMed)

Davis GM, Moscato J. Changes in lung mechanics following sighs in premature newborns without lung disease. Pediatr Pulmonol. 1994 Jan;17(1):26-30. doi: 10.1002/ppul.1950170106.

Reference Type RESULT
PMID: 8108173 (View on PubMed)

Qureshi M, Khalil M, Kwiatkowski K, Alvaro RE. Morphology of sighs and their role in the control of breathing in preterm infants, term infants and adults. Neonatology. 2009;96(1):43-9. doi: 10.1159/000201738. Epub 2009 Feb 10.

Reference Type RESULT
PMID: 19204409 (View on PubMed)

Patroniti N, Foti G, Cortinovis B, Maggioni E, Bigatello LM, Cereda M, Pesenti A. Sigh improves gas exchange and lung volume in patients with acute respiratory distress syndrome undergoing pressure support ventilation. Anesthesiology. 2002 Apr;96(4):788-94. doi: 10.1097/00000542-200204000-00004.

Reference Type RESULT
PMID: 11964584 (View on PubMed)

Mauri T, Eronia N, Abbruzzese C, Marcolin R, Coppadoro A, Spadaro S, Patroniti N, Bellani G, Pesenti A. Effects of Sigh on Regional Lung Strain and Ventilation Heterogeneity in Acute Respiratory Failure Patients Undergoing Assisted Mechanical Ventilation. Crit Care Med. 2015 Sep;43(9):1823-31. doi: 10.1097/CCM.0000000000001083.

Reference Type RESULT
PMID: 25985386 (View on PubMed)

Massaro GD, Massaro D. Morphologic evidence that large inflations of the lung stimulate secretion of surfactant. Am Rev Respir Dis. 1983 Feb;127(2):235-6. doi: 10.1164/arrd.1983.127.2.235.

Reference Type RESULT
PMID: 6687518 (View on PubMed)

Nacoti M, Spagnolli E, Bonanomi E, Barbanti C, Cereda M, Fumagalli R. Sigh improves gas exchange and respiratory mechanics in children undergoing pressure support after major surgery. Minerva Anestesiol. 2012 Aug;78(8):920-9. Epub 2012 Apr 27.

Reference Type RESULT
PMID: 22531559 (View on PubMed)

Bonacina D, Bronco A, Nacoti M, Ferrari F, Fazzi F, Bonanomi E, Bellani G. Pressure support ventilation, sigh adjunct to pressure support ventilation, and neurally adjusted ventilatory assist in infants after cardiac surgery: A physiologic crossover randomized study. Pediatr Pulmonol. 2019 Jul;54(7):1078-1086. doi: 10.1002/ppul.24335. Epub 2019 Apr 19.

Reference Type RESULT
PMID: 31004420 (View on PubMed)

Poets CF, Rau GA, Neuber K, Gappa M, Seidenberg J. Determinants of lung volume in spontaneously breathing preterm infants. Am J Respir Crit Care Med. 1997 Feb;155(2):649-53. doi: 10.1164/ajrccm.155.2.9032208.

Reference Type RESULT
PMID: 9032208 (View on PubMed)

Sindelar R, Nakanishi H, Stanford AH, Colaizy TT, Klein JM. Respiratory management for extremely premature infants born at 22 to 23 weeks of gestation in proactive centers in Sweden, Japan, and USA. Semin Perinatol. 2022 Feb;46(1):151540. doi: 10.1016/j.semperi.2021.151540. Epub 2021 Nov 10.

Reference Type RESULT
PMID: 34872750 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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SighPSU

Identifier Type: -

Identifier Source: org_study_id

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