High Frequency Oscillatory Ventilation Versus High Frequency Jet Ventilation for Congenital Diaphragmatic Hernia
High Frequency Oscillatory Ventilation Versus High Frequency Jet Ventilation as Initial Mode of Ventilation for Congenital Diaphragmatic Hernia
University of Utah
50 participants
Dec 30, 2020
INTERVENTIONAL
Conditions
Summary
The purpose of this study is to conduct a prospective study of all congenital diaphragmatic hernia (CDH) neonates managed at the University of Utah newborn intensive care unit (NICU) and Primary Children's Hospital NICU that required mechanical ventilation at birth. As both high frequency jet ventilation (HFJV) and high frequency oscillatory ventilation (HFOV) are standard approaches to ventilatory support of all neonates including CDH, CDH infants will be randomized at the time of birth or admission to either HFJV or HFOV as initial ventilator mode, stratified by position of the liver in the abdomen or thorax (if known) by 24 hours of age. Measures of oxygenation, ventilation and hemodynamics of the CDH cohort managed on HFOV compared to those on HFJV.
Eligibility
Inclusion Criteria5
- Admitted to either the University of Utah and/or Primary Children's Hospital NICU within 24 hours of birth
- Requiring mechanical ventilation
- Umbilical arterial line or peripheral arterial line in place
- Obtained signed consent
- Infant is ≤ 24 hours of age
Exclusion Criteria6
- Severe anomaly
- Chromosomal abnormalities
- Major congenital anomalies, including cardiac, central nervous system and syndromes
- Post-natal diagnosis > 24 hours of life
- Unable to obtain consent for participation
- Unable to randomize within 24 hours of life
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Interventions
HFJV provides short bursts of gas into the respiratory circuit at a rate of 240 to 600/min (4 to 11 Hz) and expiration is passive. It is used in conjunction with a conventional ventilator which provides positive end expiratory pressure (PEEP) and can also provide occasional sigh breaths.
HFOV uses a piston diaphragm to generate alternating positive and negative pressure changes to give breaths of 300 to 900/min (5-15 Hz) given over a set mean airway pressure. Both inhalation and exhalation are active.
Locations(2)
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NCT04774848