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This study evaluates the effect of non-invasive high frequency oscillations applied via a highflow nasal cannula ('Osciflow') compared to highflow nasal cannula without oscillations (HF) on desaturations and bradycardia in premature infants. It uses a crossover design. Infants are randomized to begin the study with either Osciflow or HF. Both modes are applied for 4 hours. Infants are monitored with an oximetry sensor to measure peripheral oxygen saturation (SpO2) and pulse rate, and with a transcutaneous CO2-transducer. Further measurements include respiratory rate and 'Bernese pain scale' evaluated by nursing staff and Electrical Impedance Tomography (EIT) in a subset of patients.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Osciflow | Experimental | Crossover sequence of experimental treatment and active comparator. |
|
| Highflow | Active Comparator | Crossover sequence of experimental treatment and active comparator. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Osciflow | Device | Osciflow is a non-invasive high frequency oscillatory ventilation support delivered via a highflow nasal cannula for four hours (one hour wash-out, three hours measurement period). |
| Measure | Description | Time Frame |
|---|---|---|
| Paired difference in the total number of desaturations and bradycardia between Osciflow and HF | 180-minute recording periods for each therapy |
| Measure | Description | Time Frame |
|---|---|---|
| Paired difference in respiratory rate | 180-minute recording periods for each therapy | |
| Paired difference in heart rate | 180-minute recording periods for each therapy | |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Neonatology, University Hospital Zurich | Zurich | 8091 | Switzerland |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31339005 | Background | Rub DM, Sivieri EM, Abbasi S, Eichenwald E. Effect of high-frequency oscillation on pressure delivered by high flow nasal cannula in a premature infant lung model. Pediatr Pulmonol. 2019 Nov;54(11):1860-1865. doi: 10.1002/ppul.24459. Epub 2019 Jul 24. | |
| 30549451 | Background | Sivieri EM, Eichenwald E, Bakri SM, Abbasi S. Effect of high frequency oscillatory high flow nasal cannula on carbon dioxide clearance in a premature infant lung model: A bench study. Pediatr Pulmonol. 2019 Apr;54(4):436-443. doi: 10.1002/ppul.24216. Epub 2018 Dec 14. |
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| ID | Term |
|---|---|
| D001049 | Apnea |
| D007235 | Infant, Premature, Diseases |
| ID | Term |
|---|---|
| D012120 | Respiration Disorders |
| D012140 | Respiratory Tract Diseases |
| D012818 | Signs and Symptoms, Respiratory |
| D012816 | Signs and Symptoms |
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| Highflow | Device | Standard highflow therapy without oscillations delivered via a highflow nasal cannula for four hours (one hour wash-out, three hours measurement period). |
|
| Paired difference in fraction of inspired oxygen [FiO2] |
| 180-minute recording periods for each therapy |
| Paired difference in peripheral oxygen saturation [SpO2] | 180-minute recording periods for each therapy |
| Paired difference in the proportion of time spent with oxygen saturations < 80% | 180-minute recording periods for each therapy |
| Paired difference in the proportion of time spent with heart rates < 80 bpm | 180-minute recording periods for each therapy |
| Paired difference in the number of apneas requiring stimulation | 180-minute recording periods for each therapy |
| Paired difference in transcutaneous CO2 measurements | 180-minute recording periods for each therapy |
| Paired difference in pain assessment using 'Bernese pain scale' | Bernese Pain-Scale for Neonates (BPSN): a 9-item multidimensional pain assessment tool that includes behavioral and physiological indicators. The instrument consists of seven subjective (alertness, crying, consolation, skin color, facial expression, posture, and changes in respiratory rate) and two physiological (i.e. objective) (changes in heart rate and oxygen saturation) indicators. Each item is rated on a four point Likert scale (0, 1, 2, and 3). Higher scores indicate greater pain-related distress, and a total score of 11 or higher is considered to indicate pain. | 180-minute recording periods for each therapy |
| Paired difference in end-expiratory lung impedance (EELI) in a subset of patients. | EELI using electrical impedance tomography (arbitrary units per kilogram). | At the end of each intervention period |
| Paired difference in regional ventilation distribution in a subset of patients. | Regional ventilation distribution using electrical impedance tomography (arbitrary units per kilogram). | At the end of each intervention period |
| Paired difference in Tidal volumes in a subset of patients. | Tidal volumes using electrical impedance tomography (arbitrary units per kilogram). | At the end of each intervention period |
| Paired difference in nasal trauma score | Royal Women's Hospital Nasal Integrity and Pressure Chart. Nasal injury is defined as stage 0-skin intact; stage 1-nonblanchable erythema of intact skin; stage 2-partial thickness skin loss involving epidermis, dermis, or both; stage 3-full thickness skin loss involving damage to or necrosis of subcutaneous tissue; stage 4-full thickness skin loss with extensive destruction, tissue necrosis, or damage to supporting structures. Lowest Score: 0. Highest Score: 4. A higher score indicates more extensive nasal injury. | At the end of each intervention period |
| Paired difference in the rate of pneumothorax | 180-minute recording periods for each therapy |
| Paired difference in reaching 'failure criteria' to stop Osciflow or HF therapy: | Definition of failure criteria
| 180-minute recording periods for each therapy |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D007232 | Infant, Newborn, Diseases |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |