NASAL HIGH-FREQUENCY VENTILATION FOR PREMATURE INFANTS

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。对于极低出生体重(VLBW，&lt；1500 g)早产儿，经常需要长时间的机械通气来治疗呼吸功能不全和呼吸暂停。气管插管和机械通气具有许多风险，包括可能致命的空气泄漏和呼吸机相关性肺炎。需要侵入性较小的呼吸支持方法，以将这些风险降至最低，同时支持正在康复的早产儿。该方案将测试鼻腔高频呼吸机(NHFV)对患有轻度呼吸性酸中毒的稳定新生儿的有效性，这些新生儿依赖鼻腔持续正压呼吸支持(CPAP)。鼻腔高频呼吸机可有效降低极低出生体重儿呼吸暂停或呼吸功能不全的再插管率。登记将包括60名稳定的极低出生体重儿，他们目前正在接受鼻腔CPAP治疗，并患有轻度呼吸性酸中毒。20名患者将被分配到每个接受调查的呼吸机上。鼻腔高频呼吸机将在与患者先前CPAP支持相同的平均气道压下应用。调整鼻腔高频呼吸的幅度，以达到足够的胸壁抖动。将使用血气测量、持续经皮二氧化碳分压监测、连续脉搏血氧饱和度测量和胸部X光来评估安全性和有效性。研究能力已被计算以检测二氧化碳分压的差异(下降或上升)8托，这是临床上相关的差异。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Prolonged mechanical ventilation is frequently needed to treat respiratory insufficiency and apnea in very low birth weight (VLBW, <1500 g) preterm infants. Endotracheal intubation and mechanical ventilation carry many risks including potentially fatal air leaks and ventilator-associated pneumonias. Less invasive methods of respiratory support are needed to minimize these risks while supporting the convalescing preterm infant. This protocol will test the effectiveness of nasal high-frequency ventilation (NHFV) in stable neonates with mild respiratory acidosis who are dependent on nasal continuous positive airway pressure for respiratory support (CPAP). Nasal high-frequency ventilation may be effective in decreasing rates of reintubation for apnea or respiratory insufficiency in VLBW infants. Enrollment will include 60 stable VLBW infants who are currently being treated with nasal CPAP and who have mild respiratory acidosis. Twenty patients will be assigned to each ventilator under investigation. Nasal high frequency ventilation will be applied at the same mean airway pressure as the patients' previous CPAP support. The amplitude of the nasal high frequency ventilation will be adjusted to achieve adequate shaking of the chest wall. Blood gas measurements, continuous transcutaneous PCO2 monitoring, continuous pulse oximetry, and chest x-rays will be used to assess safety and efficacy. Study power has been calculated to detect a difference (drop or rise) in PCO2 of 8 torr, a clinically relevant diffe