Continuous Evaluation of Diaphragm Function

NCT ID: NCT03941002

Last Updated: 2020-11-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

25 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-09-30

Study Completion Date

2021-06-30

Brief Summary

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Aim of mechanical ventilation is to improve gas exchange and to unload the respiratory muscles delivering a form of mechanical support to the ventilation. At the same time, it is essential that the support is individually-tailored to avoid the development of muscular atrophy, a process called "ventilatory-induced diaphragm dysfunction"

Aim of the present study is that the continuous ultrasonographic assesment of diaphragm function, as obtained by the device under investigation (DiaMon, Respinor AS, Oslo, Norway) is related to the degree of effort of inspiratory muscles, as measured by gold-standard indices such as esophageal and gastric pressure measurement.

A secondary aim is that the data assessed by the device are related to a standard ultrasonographic examination performed by expert operators.

In particular, we will enroll a population of critically ill patients undergoing mechanical ventilation in assisted mode, and we will perform a decremental pressure support trial, with the following aims:

1. to evaluate the performance of a continuous and automated device for the monitoring of diaphragm contractile activity, as compared to standard mechanical indices of respiratory effort such as the pressure-time product (PTP)
2. to evaluate the performance of a continuous and automated device for the monitoring of diaphragm contractile activity, as compared to the ultrasonographic assesment of muscle function performed by an expert operator.

Detailed Description

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Conditions

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Respiration, Artificial Mechanical Ventilation Critical Illness

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Clinical pressure support

The level of inspiratory pressure support will be selected by the attending physician

Group Type PLACEBO_COMPARATOR

Assesment of diaphragm function

Intervention Type DIAGNOSTIC_TEST

Diaphragm function will be assessed by standard mechanical parameters as assessed by esophageal and gastric pressure measurement, as well as by an ultrasonographic examination performed by an expert operator and by the continuous ultrasonographic assessment provided by the device under investigation

Reduced pressure support

The level of inspiratory pressure support will be reduced by 25%

Group Type ACTIVE_COMPARATOR

Assesment of diaphragm function

Intervention Type DIAGNOSTIC_TEST

Diaphragm function will be assessed by standard mechanical parameters as assessed by esophageal and gastric pressure measurement, as well as by an ultrasonographic examination performed by an expert operator and by the continuous ultrasonographic assessment provided by the device under investigation

Lowest pressure support

The level of inspiratory pressure support will be reduced by 50%

Group Type ACTIVE_COMPARATOR

Assesment of diaphragm function

Intervention Type DIAGNOSTIC_TEST

Diaphragm function will be assessed by standard mechanical parameters as assessed by esophageal and gastric pressure measurement, as well as by an ultrasonographic examination performed by an expert operator and by the continuous ultrasonographic assessment provided by the device under investigation

Interventions

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Assesment of diaphragm function

Diaphragm function will be assessed by standard mechanical parameters as assessed by esophageal and gastric pressure measurement, as well as by an ultrasonographic examination performed by an expert operator and by the continuous ultrasonographic assessment provided by the device under investigation

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

* Acute respiratory failure which necessitated endotracheal intubation and mechanical ventilation, with ventilation in pressure-support mode.
* Positive end-expiratory pressure (PEEP) lower than 10 cmH2O
* Pressure support level between 4 and 10 cmH2O
* Ratio between PaO2 and FiO2 \>200 mmHg
* Resolution of the cause of respiratory failure

Exclusion Criteria

* Diagnosis of Chronic Obstructive Pulmonary Disease (COPD)
* Pregnancy
* Circulatory failure
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Milan

OTHER

Sponsor Role lead

Responsible Party

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Davide Chiumello

Director of Intensive Care

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo

Milan, MI, Italy

Site Status RECRUITING

Countries

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Italy

Central Contacts

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Davide Chiumello

Role: CONTACT

+390281844476

Facility Contacts

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Davide Chiumello

Role: primary

+390281844020

Other Identifiers

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WOB-DiaMon

Identifier Type: -

Identifier Source: org_study_id