Work of breathing in preterm infants: NIV-NAVA vs SNIPPV
Research type
Research Study
Full title
A cross-over study comparing work of breathing during non-invasive neurally adjusted ventilatory assist (NIV-NAVA) and synchronised nasal intermittent positive pressure ventilation (SNIPPV) as post-extubation support in prematurely-born infants
IRAS ID
266360
Contact name
Anne Greenough
Contact email
Sponsor organisation
King's College London
Duration of Study in the UK
0 years, 6 months, 1 days
Research summary
Many infants are born at less than thirty-two weeks of gestation and a large proportion of these babies will require support with their breathing. Although life-saving, mechanical ventilation is associated with complications which are more likely with prolonged length of ventilation. Around one third of infants will 'fail' extubation within the first forty-eight hours and need to be re-intubated. Increased work of breathing and subsequent fatigue can lead to increased oxygen demand and respiratory acidosis - both of which are known causes of extubation failure. Continuous positive airway pressure (CPAP), heated high flow nasal cannula oxygen (HHHFNC) and more recently synchronised nasal intermittent positive pressure ventilation (SNIPPV) are widely used as post-extubation support. A novel form of non-invasive ventilation that allows the infants to control the degree of support required is known as non-invasive neurally adjusted ventilatory assist (NIV-NAVA). Since NIV-NAVA is a novel mode of non-invasive respiratory support there have been no studies that have compared work of breathing with this modality as a post extubation mode of respiratory support in preterm infants.
This study will look at preterm infants born who are mechanically ventilated for at least forty-eight hours and are deemed, by the clinical care team, to required ongoing positive pressure respiratory support post-extubation. Infants will be randomised to either NIV-NAVA or SNIPPV at the point of extubation. The infants will be monitored for a period of two hours, at the end of which there will be a five minute assessment of work of breathing. Trans-diaphragmatic pressure time product (PTPdi) will be measured using a dual pressure transducer tipped catheter. Thoraco-abdominal asynchrony (TAA) will be measured using respiratory inductive plethysmography. Infants will then be switched to the other modality and the observation period and work of breathing will be repeated. This will be the end of the study.
REC name
London - Riverside Research Ethics Committee
REC reference
19/LO/1229
Date of REC Opinion
27 Aug 2019
REC opinion
Further Information Favourable Opinion