Ignite Creation Date:
2024-10-26 @ 3:35 PM
Last Modification Date:
2024-10-26 @ 3:35 PM
Study NCT ID:
NCT06512935
Status:
NOT_YET_RECRUITING
Last Update Posted:
None
First Post:
2024-07-05
Brief Title:
Ventilator Pressure and Optimization of Compliance and Hemodynamics
Sponsor:
None
Organization:
None
Study Overview
Official Title:
Ventilator Pressure and Optimization of Compliance and Hemodynamics VPOCH Trial
Status:
NOT_YET_RECRUITING
Status Verified Date:
2024-10
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
No
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
VPOCH
Brief Summary:
In preterm infants 34 weeks gestation at birth receiving respiratory support with invasive positive pressure ventilation the positive end-expiratory pressure PEEP of best compliance will increase the cardiac output and improve oxygenation This study may emphasize using point-of-care echocardiography along with electrical impedance tomography EIT to optimize ventilator settings in preterm infants
Infants will be randomized to a 4-hour crossover period of increasing and decreasing PEEP in random order from baseline to determine compliance oxygenation and cardiac hemodynamics at each step using echocardiography ECHO and EIT measurements There will be a 15-minute washout period after changes prior to data collection
Infants will be randomized to a 4-hour crossover period of increasing and decreasing PEEP in random order from baseline to determine compliance oxygenation and cardiac hemodynamics at each step using echocardiography ECHO and EIT measurements There will be a 15-minute washout period after changes prior to data collection
Detailed Description:
In preterm infants 34 weeks gestation at birth receiving respiratory support with invasive positive pressure ventilation the positive end-expiratory pressure PEEP of best compliance will increase the cardiac output and improve oxygenation This study may emphasize using point-of-care echocardiography along with EIT to optimize ventilator settings in preterm infants
Neonatal ventilation is a critical intervention to support breathing for newborns with respiratory distress syndrome RDS underdeveloped lungs and evolving bronchopulmonary dysplasia BPD Positive airway pressure helps maintain patency of the airways and improves ventilation and oxygenation by maintaining the functional residual capacity FRC and keeping the alveoli patent Peak inspiratory pressure PIP and positive end-expiratory pressure PEEP are terms commonly used in mechanical ventilation to describe the pressures applied to the respiratory system during the different phases of the breathing cycle These parameters are essential in managing and optimizing ventilation for infants with respiratory failure
This study will include preterm infants with recovering RDS born at age 34 weeks of gestational age on respiratory support via conventional mechanical ventilation or on high-frequency jet ventilation HFJV Infants will be randomized to the order of testing increasing the PEEP 1 cmH2O and 2 cmH2O or decreasing the PEEP 1 cmH2O and 2 cmH2O with baseline measurements and Echo done at original PEEP and each subsequent PEEP
Following informed consent randomization will be performed using sequentially numbered sealed opaque envelopes The randomization envelope will be signed before it is opened just before starting the study on each infant to indicate the first intervention for the infant
This will be a single-center randomized crossover study The randomization envelope will be signed before it is opened just before starting the study on each infant to indicate the first intervention for the infant
Randomization will occur after a baseline assessment of cardiac hemodynamics and respiratory status at the current set PEEP level Infants will be randomized to the order of changes in PEEP levels during mechanical ventilation - increase followed by decrease versus decrease followed by increase Randomization will use opaque sealed envelopes of varying block sizes from 2-4 with a 1111 allocation ratio
Infants will be randomized to a 4-hour crossover period of increasing and decreasing PEEP in random order from baseline and there will be a 15-minute washout period after changes before data collection
All infants enrolled in the study will have routine monitoring uniform target saturation ranges of 91-95 with alarm limits set at 88-95 and standard care for the duration of the study Pulse oximetry recordings will be downloaded using ixTrend iexcellence Wildau Germany software to a secure computer system for later data analysis
Infants will continue standard treatment as recommended by the treating physician and will act as their own controls
Primary secondary outcomes are described below Electrical impedance tomography data will be collected in the Syntec machine and safely secured in the university computer system Pulse oximetry recordings will be downloaded using ixTrend software to a secure computer system for later data analysis
ECHO results will be stored in the unit ECHO machine and results will be reported by certified cardiologists blinded to the data collected to improve the study designs internal and external validity
Neonatal ventilation is a critical intervention to support breathing for newborns with respiratory distress syndrome RDS underdeveloped lungs and evolving bronchopulmonary dysplasia BPD Positive airway pressure helps maintain patency of the airways and improves ventilation and oxygenation by maintaining the functional residual capacity FRC and keeping the alveoli patent Peak inspiratory pressure PIP and positive end-expiratory pressure PEEP are terms commonly used in mechanical ventilation to describe the pressures applied to the respiratory system during the different phases of the breathing cycle These parameters are essential in managing and optimizing ventilation for infants with respiratory failure
This study will include preterm infants with recovering RDS born at age 34 weeks of gestational age on respiratory support via conventional mechanical ventilation or on high-frequency jet ventilation HFJV Infants will be randomized to the order of testing increasing the PEEP 1 cmH2O and 2 cmH2O or decreasing the PEEP 1 cmH2O and 2 cmH2O with baseline measurements and Echo done at original PEEP and each subsequent PEEP
Following informed consent randomization will be performed using sequentially numbered sealed opaque envelopes The randomization envelope will be signed before it is opened just before starting the study on each infant to indicate the first intervention for the infant
This will be a single-center randomized crossover study The randomization envelope will be signed before it is opened just before starting the study on each infant to indicate the first intervention for the infant
Randomization will occur after a baseline assessment of cardiac hemodynamics and respiratory status at the current set PEEP level Infants will be randomized to the order of changes in PEEP levels during mechanical ventilation - increase followed by decrease versus decrease followed by increase Randomization will use opaque sealed envelopes of varying block sizes from 2-4 with a 1111 allocation ratio
Infants will be randomized to a 4-hour crossover period of increasing and decreasing PEEP in random order from baseline and there will be a 15-minute washout period after changes before data collection
All infants enrolled in the study will have routine monitoring uniform target saturation ranges of 91-95 with alarm limits set at 88-95 and standard care for the duration of the study Pulse oximetry recordings will be downloaded using ixTrend iexcellence Wildau Germany software to a secure computer system for later data analysis
Infants will continue standard treatment as recommended by the treating physician and will act as their own controls
Primary secondary outcomes are described below Electrical impedance tomography data will be collected in the Syntec machine and safely secured in the university computer system Pulse oximetry recordings will be downloaded using ixTrend software to a secure computer system for later data analysis
ECHO results will be stored in the unit ECHO machine and results will be reported by certified cardiologists blinded to the data collected to improve the study designs internal and external validity
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None