Impact of CPAP level on ventilation/perfusion mismatch and shunt in premature infants; a pilot randomized controlled trial
BACKGROUND: Bronchopulmonary dysplasia (BPD) is a chronic lung disease resulting from prematurity associated with increased mortality and long-term respiratory and neurodevelopmental impairments in survivors. The preferential use of continuous positive airway pressure (CPAP) over mechanical ventilation is an evidence-based preventive strategy with modest benefit. Many infants fail initial CPAP due to oxygenation failure caused by ventilation/perfusion mismatch. Optimizing CPAP pressure levels to minimize V/Q mismatch may increase the benefit of CPAP.
GAP: A critical knowledge gap exists for a basic aspect of therapy: how much CPAP pressure should be used?
HYPOTHESIS: We hypothesize that implementation of an individualized CPAP level selection strategy will decrease ventilation/perfusion (V/Q) mismatch by >10%.
METHODS: We will conduct a phase II, single-arm prospective clinical trial in premature infants measuring within-subject changes in V/Q mismatch before and after implementation of an individualized CPAP level selection strategy; clinicaltrials.gov: NCT02983825.
IMPACT: Confirmation of decreased V/Q mismatch in response to an individualized CPAP level selection strategy will motivate subsequent studies assessing the impact of this strategy on outcomes such as CPAP failure and BPD.
Website Link: http://www.chop.edu/doctors/bamat-nicolas