Nasal HFOV Versus Nasal SIPPV in Neonate Following Extubation: RCT Crossover Study

NCT04323397 | Completed Results DMC

• 1 other identifier: 6238211
• Study Type: interventional
• Target: 133
• Locations: 1 country
• Sites: 1

Brief Summary

Mechanical ventilation was introduced to treat respiratory failure in preterm infants or sick neonates then improvements in survival (1,2). However, the complications from short or long term use of ventilation can result in unintended harm or burden (e.g., air leak syndrome, pneumonia, bronchopulmonary dysplasia, neurological injury, retinopathy of prematurity) (3,4). To reduce these risks, clinicians should aggressive extubated neonates as early as possible. Respiratory (focus on blood gas as well as partial pressure CO2 \[pCO2\]) or extubation (focus on clinical condition as well as reintubation) failure was worrisome in pediatrician and parents if the neonate was reintubated owing to complete recovery of lung disease or inadequate respiratory drive. Non-invasive ventilation (NIV) was supported for primary respiratory support (initial mode before endotracheal intubation) or post-extubation. Nasal continuous positive airway pressure (nCPAP) was familiar to NIV mode in neonatal respiratory support. Nowadays, the new NIV modalities are nasal intermittent synchronized positive pressure ventilation (nSIPPV) and nasal high frequency oscillation (nHFO). To increase the likelihood of nCPAP success, other new modalities of NIV may be interesting. From theory, nSIPPV and nHFO combines peak inspiratory pressure (PIP) with synchrony and high-frequency oscillations without synchrony above CPAP, respectively. From meta-analysis, nSIPPV and nHFO were statistically significant superior than nCPAP both respiratory and extubation failure in neonate (5,6). The aim of our study was to investigate the efficacy of nHFOV and nSIPPV for CO2 clearance and reintubation rate after extubated neonates. The investigators hypothesized that nHFOV mode would improve CO2 clearance better than nSIPPV mode.

Conditions

High-Frequency Ventilation; Intermittent Positive-Pressure Ventilation; Newborn Morbidity; Noninvasive Ventilation

Keywords

Nasal High-Frequency Oscillation; Nasal Synchronized Intermittent Positive Pressure; Respiratory Failure; Extubation Failure

Outcome Measures

Primary Outcomes (1)

• Partial Pressure CO2 (pCO2) : Data From the Crossover Phase of the Study

  Data from the Crossover Phase of the study: After randomization only in neonate with arterial line, the initial non-invasive ventilation (NIV) was started then blood gas was obtained after 2 hours. The participant was switched to another NIV and blood gas was obtained after 2 hours.

  2 hours after each intervention

Secondary Outcomes (1)

• Number of Participants With Extubation Failure: Data From the Parallel Phase of the Study.

  up to 7 days after each intervention

Study Arms (2)

nasal high frequency oscillatory ventilation

EXPERIMENTAL

nHFO: flow 8-10 L/minute, frequency 10 Hz, MAP = "MAP (before extubation) + 2" or "8 (preterm), 10 (term)" cmH2O, dP = "2-3 times of MAP with visible chest oscillations" or 25-35 cmH2O, I:E = 1:1, FiO2 = "FiO2 (before extubation) + 0.1-0.2" keep targeted SpO2 90-94%

Device: Non-invasive ventilation

nasal synchronized intermittent positive pressure ventilation

EXPERIMENTAL

nSIPPV: flow 8-10 L/minute, rate 60/minute, PIP = "PIP (before extubation) + 2-5" or "20 (preterm), 25 (term)" cmH2O, PEEP = 5 cmH2O, IT = 0.5 s, FiO2 = "FiO2 (before extubation) + 0.1-0.2" keep targeted SpO2 90-94%. The highest trigger sensitivity avoiding auto triggering was selected.

Device: Non-invasive ventilation

Interventions

Non-invasive ventilation DEVICE

Intervention nasal high frequency oscillatory ventilation (nHFOV) and nasal synchronized intermittent positive pressure ventilation (nSIPPV) were generated by neonatal ventilators (SLE6000 infant ventilators, United Kingdom) using bi-nasal prongs (RAM cannula, NEOTECH®, USA) or the nasal mask of the same type for both ventilation modes. The size of the prongs was determined by the infant's weight. The largest possible prongs were used, with a snug fit to avoid leakage. Pacifier for preterm and term neonate (Jollypop™, USA) was taken to avoid leakage from the mouth. The disposable ventilator circuit (Fisher \& Paykel RT268™, Evaqua Dual Limb Infant Breathing Circuit Kit with Evaqua 2 Technology and Pressure Line, Flow \> 4L/min, New Zealand) was used. The initial NIV setting was (7) described in arm description. (above)

nasal high frequency oscillatory ventilation; nasal synchronized intermittent positive pressure ventilation

Eligibility Criteria

• Age: 1 Day - 1 Month
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Born in hospital and admit in NICU
• The first endotracheal intubation and need NIV if extubation
• Umbilical arterial catheterization to draw the blood gas
• Neonate has not been intervened from another RCT study

You may not qualify if:

• Major congenital anomalies or chromosomal abnormalities
• Neuromuscular diseases
• Upper respiratory tract abnormalities
• Suspected congenital lung diseases or pulmonary hypoplasia
• Need for surgery known before the first extubation
• Grade IV intraventricular hemorrhage occurring before the first extubation
• Palliative care
• Parents' decision not to participate

Sponsors & Collaborators

• Prince of Songkla University: lead

Study Sites (1)

Songklanagarind Hospital, Prince of Songkla University

Hat Yai, Changwat Songkhla, 90110, Thailand

Location

Related Publications (4)

• Baingam K, Phatigomet M, Thatrimontrichai A, Maneenil G, Dissaneevate S, Janjindamai W. Carbon Dioxide Level between Nasal High-Frequency Oscillatory Ventilation and Synchronized Nasal Intermittent Positive Pressure Ventilation after Extubation in Neonates: A Cross-over Randomized Controlled Trial. Am J Perinatol. 2024 Aug;41(11):1495-1503. doi: 10.1055/a-2113-3284. Epub 2023 Jun 20.

  PMID: 37339671 RESULT

• Phatigomet M, Thatrimontrichai A, Maneenil G, Dissaneevate S, Janjindamai W. Reintubation Rate between Nasal High-Frequency Oscillatory Ventilation versus Synchronized Nasal Intermittent Positive Pressure Ventilation in Neonates: A Parallel Randomized Controlled Trial. Am J Perinatol. 2024 Aug;41(11):1504-1511. doi: 10.1055/a-2118-5351. Epub 2023 Jun 27.

  PMID: 37369239 RESULT

• Baingam K, Phatigomet M, Thatrimontrichai A, Maneenil G, Dissaneevate S, Janjindamai W. Erratum: Carbon Dioxide Level between Nasal High-Frequency Oscillatory Ventilation and Synchronized Nasal Intermittent Positive Pressure Ventilation after Extubation in Neonates: A Cross-over Randomized Controlled Trial. Am J Perinatol. 2024 Aug;41(11):e1. doi: 10.1055/s-0044-1778715. Epub 2024 Jan 24. No abstract available.

  PMID: 38266755 RESULT

• Phatigomet M, Thatrimontrichai A, Maneenil G, Dissaneevate S, Janjindamai W. Erratum: Reintubation Rate between Nasal High-Frequency Oscillatory Ventilation versus Synchronized Nasal Intermittent Positive Pressure Ventilation in Neonates: A Parallel Randomized Controlled Trial. Am J Perinatol. 2024 Aug;41(11):e2. doi: 10.1055/s-0044-1778714. Epub 2024 Jan 24. No abstract available.

  PMID: 38266756 RESULT

MeSH Terms

Conditions

Respiratory Insufficiency

Interventions

Noninvasive Ventilation

Condition Hierarchy (Ancestors)

Respiration Disorders; Respiratory Tract Diseases

Intervention Hierarchy (Ancestors)

Respiration, Artificial; Airway Management; Therapeutics; Respiratory Therapy

Results Point of Contact

• Title: Anucha Thatrimontrichai
• Organization: Prince of Songkla University

tanucha@medicine.psu.ac.th

66 74451257

Study Officials

• Anucha Thatrimontrichai, M.D.

  Prince of Songkla University

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Model Details: Randomized Controlled Crossover Study

Study Record Dates

• First Submitted: March 25, 2020
• First Posted: March 26, 2020
• Study Start: July 1, 2020
• Primary Completion: June 30, 2022
• Study Completion: August 1, 2022
• Last Updated: March 3, 2025
• Results First Posted: March 3, 2025

Record last verified: 2025-02

Data Sharing

• IPD Sharing: Will not share

Locations

TH (1)