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Trial record 9 of 27 for:    Recruiting, Not yet recruiting, Available Studies | "Infant, Low Birth Weight"

Nasal Noninvasive NAVA in the Very Low Birth Weight Infant

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ClinicalTrials.gov Identifier: NCT01785563
Recruitment Status : Recruiting
First Posted : February 7, 2013
Last Update Posted : August 9, 2018
Sponsor:
Information provided by (Responsible Party):
Tarah T Colaizy, University of Iowa

Brief Summary:
The purpose of this study is to determine if a new type of mechanical ventilation, or breathing machine (called neurally adjusted ventilatory assist or NAVA), will provide additional support to infants who were born prematurely. Investigators are looking to determine if in two hours infants who weighed less than 1500 grams or 3 pounds 5 ounces, will demonstrate a decrease in the amount of carbon dioxide (the gas that humans exhale) dissolved in their blood as compared to prior to starting the study. This will be accomplished by enrolling infants who are stable on their current type of mechanical breathing that provides a constant air flow into the infant. This type of mechanical support helps keep the lungs inflated but does not help remove carbon dioxide. This study will change the type of mechanical support to a type of support called neurally adjusted ventilatory assist or NAVA. This type of mechanical support detects when the infant is breathing in by having electrical sensors on a feeding tube that is placed into the stomach through the nose or mouth. These electrical sensors detect when the diaphragm or the muscle that helps humans breath is trying to take a breath in. When the NAVA ventilator senses the attempt to breath, it provides additional air flow to make the effort of breathing easier. The ventilator will be attached to a tube or cannula that is placed into the infant's nose. After two hours of being on the NAVA ventilator a repeat measure of carbon dioxide in the blood will be performed by taking a small amount of blood from the infant's heel.

Condition or disease Intervention/treatment Phase
Inadequate; Pulmonary Ventilation, Newborn Infant, Very Low Birth Weight Device: Nasal NIV-NAVA Not Applicable

Detailed Description:

Baseline Data Collection:

Demographic data: Patient gestational age at delivery, maternal betamethasone therapy, APGAR scores, admission weight, receipt of surfactant administered, age at extubation, time since extubation, current post menstrual age, and current weight.

Baseline vitals and ventilation mode: Heart rate, blood pressure, FiO2, oxygen saturations, transcutaneous partial pressure of carbon dioxide (TCO2) and current mode of ventilation will be recorded four times in a one minute period and the values average to minimize normal variation. Intervention time will be manipulated to begin no later than one hour after the previous feeding, as to minimize interruption of feedings to no greater than 30 minutes.

Safety Safety: TCO2 monitor will be attached to the infant and the device will be calibrated according to protocol (reference TCO2 monitor manual). Carbon dioxide diffusion through the skin will be monitored continuously during the intervention (Bromley 08) to avoid periods of hypo or hypercarbia.

Edi Catheter placement: Edi catheter size will be selected according to infant's weight and length. It will be inserted according to manufacturer's guidelines and adjustments will be made to optimize positioning (reference NAVA manual).

NAVA settings:

Infants will be maintained on previous level of PEEP or calculated PEEP, rounding up to whole numbers. Initial NAVA level will be determined by starting with an initial NAVA level of 0.5 microvolts/cm of H20. The NAVA level will then be adjusted either by increasing or decreasing to generate a PIP that is a minimum of 8 cm of H2O greater than the current PEEP. Apnea alarm will be set at 5 seconds, which will initiate the NAVA back up setting if no electrical activity is detected by the Edi catheter. Back up NAVA settings will be set with a PIP of 12 cm of H20 greater than current PEEP, respiratory rate of 60 breaths per minute (RR) and inspiratory time of 0.5 seconds. Fraction of inspired oxygen (FiO2) will be adjusted to keep infant's oxygen saturations within previously established clinical parameters.

Study Intervention Procedure and Data Collection:

At initiation of intervention, and at time 30, 60, 90, and 120 minutes, heart rate (HR), respiratory rate (RR), tidal volume (TV), minute ventilation, FiO2, oxygen saturations, peak Edi and PIP will be recorded four times in a one minute period and the values average to minimize normal variation. Current NAVA settings, TCO2, and blood pressure (BP) will also be recorded. At 60 minutes of intervention if the TCO2 level has not decreased by 5 torr from baseline or has risen, the current NAVA level will be increased by 50%. At 90 minutes if the TCO2 level has not decreased by 5 torr from baseline or has risen; the NAVA level will be increased by 50% from the current level. At the completion of the study (120 minutes or pCO2 outside of established limits) the HR, RR, BP, TV, minute ventilation, FiO2, oxygen saturations, peak Edi and PIP will be recorded four times in a one minute period and the values average to minimize normal variation. A capillary blood gas will be obtained according to standard unit protocol with a warmed heel.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 60 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Nasal Noninvasive NAVA Provides Ventilation in the Very Low Birth Weight Infant
Study Start Date : February 2013
Estimated Primary Completion Date : December 2018
Estimated Study Completion Date : December 2018


Arm Intervention/treatment
Experimental: Nasal NIV-NAVA
Infants will be transitioned from their current mode of ventilation to nasal NIV-NAVA. If patients are currently on nasal NIV-NAVA an increase in the NAVA level will be utilized for the intervention.
Device: Nasal NIV-NAVA
Infants will be placed on nasal NIV-NAVA. Patients initial NAVA level will be set to generate a peak inspiratory pressure that is 8 cm of water greater than their current peak end expiratory pressure. If the infants are on nasal NIV-NAVA at the time of study entry their NAVA level will be increased by 50% rounded up to the nearest 0.1 cm of water per microvolt.
Other Names:
  • noninvasive
  • neurally adjusted ventilatory assist
  • nasal pharyngeal




Primary Outcome Measures :
  1. Decrease in partial pressure of carbon dioxide on capillary blood gas [ Time Frame: 2 hours ]

Secondary Outcome Measures :
  1. Decrease in fraction of inspired oxygen [ Time Frame: 2 hours ]


Information from the National Library of Medicine

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Ages Eligible for Study:   up to 1 Year   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • birth weight less than 1,500 grams
  • Clinical history of respiratory distress syndrome treated with surfactant
  • Chronological age greater than or equal to seven days
  • 48 hours post-extubation or greater
  • Medically stable per primary medical team
  • Receiving ventilatory support on one of the following systems via nasal pharyngeal tube or nasal prongs:continuous positive airway pressure (CPAP), intermittent mechanical ventilation (IMV), or neutrally adjusted ventilatory assistance (NAVA)
  • Receiving ventilatory support via high flow nasal cannula if the flow is large enough to provide a positive end expiratory pressure (PEEP) of 6 as defined by PEEP of 6 = 0.68 * weight (kg) + 0.92
  • Capillary blood gas via heel stick within 24 hours that demonstrates a pH of less than or equal to 7.35 and/or a partial pressure of carbon dioxide (pCO2) greater than or equal to 45 mmHg

Exclusion criteria:

  • Severe congenital abnormalities
  • Grade III or IV interventricular hemorrhage.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01785563


Contacts
Contact: Tarah J Colaizy, M.D. 319-356-7096 tarah-colaizy@uiowa.edu
Contact: Tarah T. Colaizy, M.D., MPH 319-356-3508 tarah-colaizy@uiowa.edu

Locations
United States, Iowa
Children's Hospital of Iowa NICU Recruiting
Iowa City, Iowa, United States, 52242
Principal Investigator: Tarah T Colaizy, MD, MPH         
University of Iowa Recruiting
Iowa City, Iowa, United States, 52242
Contact: Tarah Colaizy, MD, MPH    319-356-3508      
Principal Investigator: Tarah T Colaizy, MD, MPH         
Sponsors and Collaborators
Tarah T Colaizy
Investigators
Principal Investigator: Tarah T Colaizy, M.D., MPH University of Iowa
Study Director: Gary J Kummet, M.D. University of Iowa
Study Director: Jonathan C Klein, M.D. University of Iowa

Publications of Results:

Responsible Party: Tarah T Colaizy, Principal Investigator, University of Iowa
ClinicalTrials.gov Identifier: NCT01785563     History of Changes
Other Study ID Numbers: 201208771
First Posted: February 7, 2013    Key Record Dates
Last Update Posted: August 9, 2018
Last Verified: August 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: Yes
Device Product Not Approved or Cleared by U.S. FDA: No
Pediatric Postmarket Surveillance of a Device Product: No
Product Manufactured in and Exported from the U.S.: No

Keywords provided by Tarah T Colaizy, University of Iowa:
NAVA
NIV-NAVA
VLBW
electrical activity of the diaphragm
neural trigger, mechanical ventilation
respiratory distress syndrome

Additional relevant MeSH terms:
Body Weight
Birth Weight
Signs and Symptoms