Application of two different nasal CPAP levels for the treatment of respiratory distress syndrome in preterm infants—“The OPTTIMMAL-Trial”—Optimizing PEEP To The IMMAture Lungs: study protocol of a randomized controlled trial

Trials

Corinna Engel¹  Axel R. Franz²  Klaus-Peter Zimmer³  Annesuse Schmidt³  Markus Waitz³  Harald Ehrhardt⁴  Julia Sandkötter⁵  Katja Masjosthusmann⁵  Philipp Deindl⁶  Dominique Singer⁶  Ulrich Rochwalsky⁷  Rolf Schloesser⁷  Corinna Peter⁸  Bettina Bohnhorst⁸  Michael Zemlin⁹  Paul Hoffmann⁹  Alexander Larsen⁹  Sascha Meyer⁹  Marc Hoppenz^1,10  Thomas Pabst^1,10  Eric Frieauff^1,11  Christoph Haertel^1,11 

[1] Center for Pediatric Clinical Studies, University of Tübingen, Frondsbergstraße 23, 72070, Tübingen, Germany;Center for Pediatric Clinical Studies, University of Tübingen, Frondsbergstraße 23, 72070, Tübingen, Germany;Department of Neonatology and Center for Pediatric Clinical Studies, University of Tübingen, Calwerstr. 7, 72076, Tübingen, Germany;Department of General Pediatrics and Neonatology, Center for Child and Adolescent Medicine, Justus-Liebig-University, Feulgenstraße 12, 35392, Gießen, Germany;Department of General Pediatrics and Neonatology, Center for Child and Adolescent Medicine, Justus-Liebig-University, Feulgenstraße 12, 35392, Gießen, Germany;German Center for Lung Research (DZL), Universities of Giessen and Marburg Lung Center (UGMLC), Feulgenstraße 12, 35392, Gießen, Germany;Department of General Pediatrics, University Children’s Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany;Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany;Division of Neonatology, University of Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany;Division of Pediatric Pulmonology, Allergology and Neonatology Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany;Neonatal Intensive Care Unit, Department of Pediatrics and Neonatology, Saarland University Medical Center, Kirrbergerstrasse 100, 66421, Homburg, Germany;Neonatology and Pediatric Intensive Care Medicine, Hospital Cologne, Amsterdamer Strasse 59, 50735, Köln, Germany;University Children’s Hospital, University of Würzburg, Josef-Schneider-Str. 2, 97080, Wuerzburg, Germany;

关键词: Nasal CPAP;    RDS;    Preterm infants;    PEEP;   

DOI  :  10.1186/s13063-020-04660-0

来源: Springer

【 摘 要 】

BackgroundNasal continuous positive airway pressure (CPAP) applies positive end-expiratory pressure (PEEP) and has been shown to reduce the need for intubation and invasive mechanical ventilation in very low birth weight infants with respiratory distress syndrome. However, CPAP failure rates of 50% are reported in large randomized controlled trials. A possible explanation for these failure rates is the application of insufficient low levels of PEEP during nasal CPAP treatment to maintain adequate functional residual capacity shortly after birth. The optimum PEEP level to treat symptoms of respiratory distress in very low birth weight infants has not been assessed in clinical studies. The aim of the study is to compare two different PEEP levels during nasal CPAP treatment in preterm infants.MethodsIn this randomized multicenter trial, 216 preterm infants born at 26 + 0–29 + 6 gestational weeks will be allocated to receive a higher (6–8 cmH2O) or a lower (3–5 cmH2O) PEEP during neonatal resuscitation and the first 120 h of life. The PEEP level within each group will be titrated throughout the intervention based on the FiO2 (fraction of inspired oxygen concentration) requirements to keep oxygenation within the target range. The primary outcome is defined as the need for intubation and mechanical ventilation for > 1 h or being not ventilated but reaching one of the two pre-defined CPAP failure criteria (FiO2 > 0.5 for > 1 h or pCO2 ≥ 70 mmHg in two consecutive blood gas analyses at least 2 h apart).DiscussionBased on available data from the literature, the optimum level of PEEP that most effectively treats respiratory distress syndrome in preterm infants is unknown, since the majority of large clinical trials applied a wide range of PEEP levels (4–8 cmH2O). The rationale for our study hypothesis is that the early application of a higher PEEP level will more effectively counteract the collapsing properties of the immature and surfactant-deficient lungs and that the level of inspired oxygen may serve as a surrogate marker to guide PEEP titration. Finding the optimum noninvasive continuous distending pressure during early nasal CPAP is required to improve CPAP efficacy and as a consequence to reduce the exposure to ventilator-induced lung injury and the incidence of chronic lung disease in this vulnerable population of very preterm infants.Trial registrationdrks.de DRKS00019940. Registered on March 13, 2020

【 授权许可】

CC BY