Nasal High-frequency Jet Ventilation (nHFJV) Following Extubation in Preterm Infants



Status:Not yet recruiting
Conditions:Cardiology, Hospital, Women's Studies, Pulmonary
Therapuetic Areas:Cardiology / Vascular Diseases, Pulmonary / Respiratory Diseases, Other, Reproductive
Healthy:No
Age Range:Any
Updated:12/19/2018
Start Date:February 1, 2019
End Date:May 31, 2020
Contact:Kristina Gulliver, MD
Email:kristina.gulliver@hsc.utah.edu
Phone:801-581-7052

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Very low birth weight infants are at increased risk of requiring prolonged duration of
mechanical ventilation and multiple intubations, both of which are risk factors for
ventilator-induced lung injury and BPD. Thus, it is important to investigate respiratory
support methods that are able to effectively oxygenate and ventilate these high risk preterm
infants while reducing their risk of lung injury. Nasal high-frequency ventilation is one
potential intervention that may decrease the risk of respiratory failure in very low birth
weight infants. Small studies have shown effective respiratory support over short time
periods in infants, however these studies use nasal high-frequency oscillatory ventilation.
To the investigators' knowledge there is no published studies looking at the use of nasal
high-frequency jet ventilation in this high risk population.

Use of non-invasive high frequency ventilation (HFV) has been described as a rescue method
following failure of other non-invasive ventilator modes or as a means to increase the
success post-extubation. When used as invasive high frequency ventilation, high frequency
oscillatory ventilation (HFOV) or high frequency jet ventilation (HFJV) utilize
supraphysiologic respiratory rates and small tidal volumes which has been shown to inflict
less lung injury than conventional modes of ventilation.

Using a mechanical newborn lung model, nasal HFV has improved CO2 removal when compared to
conventional NIPPV. Animal studies in the lab of Kurt Albertine have shown improved
ventilation and oxygenation in the high frequency nasal ventilation group versus the
mechanical ventilation group in a preterm lamb model leading towards better alveolar
formation noted histologically.

The investigators hypothesize that extubation of very preterm infants to nHFJV will
significantly decrease the rates of reintubation compared to those infants extubated to
NIPPV.


Inclusion Criteria:

- 24 0/7 to 28 6/7 weeks GA

- Intubated within 24 hours of life to synchronized intermittent mandatory ventilation
(SIMV) or high frequency ventilation (HFV, includes HFOV or HFJV)

- Plan for extubation within 72 hours of life

- Infants intubated for surfactant replacement therapy via INSURE method
(Intubation-Surfactant-Extubation) are eligible

- Consent obtained from parent/legal guardian

Exclusion Criteria:

- Major congenital and/or chromosomal anomalies

- Upper oropharyngeal anomalies
We found this trial at
2
sites
201 Presidents Circle
Salt Lake City, Utah 84108
801) 581-7200
Principal Investigator: Kristina Gulliver, MD
Phone: 801-213-3360
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Salt Lake City, Utah 84143
Principal Investigator: Kristina Gulliver, MD
Phone: 801-507-7675
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