Work of breathing in preterm infants: SNIPPV v HHHFNC
Research type
Research Study
Full title
A randomised cross-over study comparing work of breathing in synchronised nasal intermittent positive pressure ventilation (SNIPPV) and heated humidified high flow nasal cannula (HHHFNC) as post-extubation support in prematurely-born infants
IRAS ID
222649
Contact name
Anne Greenough
Contact email
Sponsor organisation
King's College London
Duration of Study in the UK
0 years, 8 months, 31 days
Research summary
Over 11,000 babies a year are born at or under 32 weeks gestation in the UK, many of whom will need support with breathing. Although life-saving, mechanical ventilation is associated with complications which are more likely with prolonged length of ventilation. Even with non-invasive respiratory support, around 30% ‘fail’ extubation within the first 48 hours and need to be reintubated. Increased work of breathing and subsequent fatigue can lead to increased oxygen demand and respiratory acidosis; these are known causes of extubation failure.
Humidified high flow nasal cannula oxygen (HHHFNC), continuous positive airway pressure (CPAP) and nasal intermittent positive pressure ventilation (NIPPV) are widely used as post-extubation support. HHHFNC and CPAP have been shown to similarly effective in reducing work of breathing. SNIPPV may reduce work of breathing in infants compared to use of CPAP. However there are no studies that compare the effectiveness of SNIPPV with HHHFNC in reducing work of breathing in these infants.
This study, conducted at a tertiary neonatal intensive care unit, will look at infants born at less than or equal to 32+0 weeks gestation who are mechanically ventilated for at least 48 hours and will require ongoing respiratory support post-extubation.
18 infants will be recruited to a crossover study. The crossover design allows each infant to act as their own control. Immediately after extubation they will receive two hours each of SNIPPV and HHFNC delivered in a random order. We will assess how hard the infant is working to breathe at the end of each two hour period by measuring the movements of the chest and abdomen and the also the work done by the diaphragm (breathing muscle.) Results for SNIPPV and HHFNC will be compared to see which mode reduces the work of breathing more effectively.REC name
London - Riverside Research Ethics Committee
REC reference
17/LO/0385
Date of REC Opinion
29 Mar 2017
REC opinion
Further Information Favourable Opinion