The Diaphragmatic Initiated Ventilatory Assist (DIVA) Trial

NCT ID: NCT05446272

Last Updated: 2025-10-07

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

RECRUITING

Clinical Phase

NA

Total Enrollment

478 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-08-03

Study Completion Date

2027-03-31

Brief Summary

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DIVA is a pragmatic randomized clinical trial (RCT) to determine: among (P) preterm infants born 23 0/7-28 6/7 weeks gestation undergoing extubation from mechanical ventilation, whether (I) Non-invasive neurally adjusted ventilatory assist (NIV-NAVA) (C) compared with Non-synchronized nasal intermittent positive pressure ventilation (NS-NIPPV), will reduce the incidence of (O) extubation failure within (T) 5 days (120 hours) of extubation.

Detailed Description

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Bronchopulmonary dysplasia (BPD) is the most common complication of prematurity and is the leading respiratory cause of childhood morbidity. Ventilator induced lung injury (VILI) an accepted and important contributor to BPD. Exposure to oxygen and positive pressure ventilation leads to developmental arrest and parenchymal injury in the immature preterm lung. Because even brief exposure to intubated positive pressure ventilation is injurious, avoiding invasive mechanical ventilation is the most widely acknowledged strategy to prevent VILI and the long-term sequela of BPD. Therefore, time on ventilators and rates of successful extubation are important endpoints of therapy.

Non-invasive neurally adjusted ventilatory assist (NIV-NAVA) is an FDA approved technology that consistently synchronizes non-invasive respiratory support with infant respiratory drive. The Diaphragmatic Initiated Ventilatory Assist (DIVA) trial is an unblinded, pragmatic, multicenter phase III randomized clinical trial in extremely preterm infants 23 0/7- 28 6/7 weeks gestational age to determine if NIV-NAVA, compared with non-synchronized nasal intermittent positive pressure ventilation (NS-NIPPV), prevents extubation failure within 5 days (120 hours) of extubation from mechanical ventilation

Conditions

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Extubation Failure Bronchopulmonary Dysplasia Death

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Investigators
Trial PIs are unaware of treatment allocation for individual subjects

Study Groups

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NIV-NAVA

Group Type EXPERIMENTAL

NIV-NAVA

Intervention Type DEVICE

Infants in the intervention arm will be managed with non-invasive neurally adjusted ventilatory assist (NIV-NAVA) using FDA-approved servos with associated FDA-approved Edi catheter.

NS- NIPPV

Group Type ACTIVE_COMPARATOR

NS-NIPPV

Intervention Type DEVICE

Infants in the active comparator arm will be treated with non-synchronized non-invasive positive pressure ventilation (NIPPV) through FDA-approved ventilators currently in use at each site.

Interventions

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NIV-NAVA

Infants in the intervention arm will be managed with non-invasive neurally adjusted ventilatory assist (NIV-NAVA) using FDA-approved servos with associated FDA-approved Edi catheter.

Intervention Type DEVICE

NS-NIPPV

Infants in the active comparator arm will be treated with non-synchronized non-invasive positive pressure ventilation (NIPPV) through FDA-approved ventilators currently in use at each site.

Intervention Type DEVICE

Other Intervention Names

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Non-invasive Neurally Adjusted Ventilatory Assist Non-synchronized Non-invasive Positive Pressure Ventilation

Eligibility Criteria

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Inclusion Criteria

* Gestational age of 23 0/7- 28 6/7 weeks at birth
* Intubated in the first 7 days of life
* Undergoing extubation following at least 12 hours of invasive mechanical ventilation
* Post-natal age \<32 weeks Post menstrual age at time of extubation

Exclusion Criteria

* Major congenital anomalies, including pulmonary hypoplasia
* Neurologic disorders affecting respiratory drive (other than apnea of prematurity)
* Esophageal bleeding or other contraindication to NG/OG catheter placement
* Current weight \<500 grams (based on Edi catheter approval)
* Study ventilator not available at time eligibility criteria are met
* Planned surgery or invasive procedure within 5 days of extubation
* Informed consent not provided
Minimum Eligible Age

0 Days

Maximum Eligible Age

9 Weeks

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Heart, Lung, and Blood Institute (NHLBI)

NIH

Sponsor Role collaborator

University of Pennsylvania

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Elizabeth Foglia

Role: PRINCIPAL_INVESTIGATOR

CHOP/UPENN

Locations

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Arkansas Children's Hospital

Little Rock, Arkansas, United States

Site Status RECRUITING

Loma Linda University

Loma Linda, California, United States

Site Status TERMINATED

Sharp Mary Birch

San Diego, California, United States

Site Status RECRUITING

Joe DiMaggio Children's Hospital

Hollywood, Florida, United States

Site Status RECRUITING

AdventHealth

Orlando, Florida, United States

Site Status RECRUITING

Peyton Manning Children's Hospital

Indianapolis, Indiana, United States

Site Status RECRUITING

Norton Children's Hospital

Louisville, Kentucky, United States

Site Status RECRUITING

Children's Mercy Hospital

Kansas City, Missouri, United States

Site Status RECRUITING

Washington University in St.Louis

St Louis, Missouri, United States

Site Status RECRUITING

Virtua Vorhees Hospital

Voorhees Township, New Jersey, United States

Site Status RECRUITING

Levine Children's Hospital

Charlotte, North Carolina, United States

Site Status RECRUITING

Atrial Health Brenner Children's Hospital( Wake Forest)

Winston-Salem, North Carolina, United States

Site Status RECRUITING

Nationwide Children's Hospital

Columbus, Ohio, United States

Site Status RECRUITING

Hospital of the University of Pennsylvania

Philadelphia, Pennsylvania, United States

Site Status RECRUITING

Intermountain Medical Center

Murray, Utah, United States

Site Status RECRUITING

Utah Valley Hospital

Provo, Utah, United States

Site Status RECRUITING

Children's Hospital of Richmond

Richmond, Virginia, United States

Site Status RECRUITING

Sunnybrook Health Sciences Centre

Toronto, Ontario, Canada

Site Status RECRUITING

Mt Sinai Hospital

Toronto, , Canada

Site Status RECRUITING

BC Children's and Women's Hospital

Vancouver, , Canada

Site Status RECRUITING

Countries

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United States Canada

Central Contacts

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Elizabeth Foglia

Role: CONTACT

267-441-7144

Lisa Wesby, MS

Role: CONTACT

215-573-6318

Facility Contacts

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David Matlock

Role: primary

Anup Katheria

Role: primary

Bruce Shulman

Role: primary

Samarth Shukla

Role: primary

Markus Tauscher

Role: primary

Dan Stewart

Role: primary

Christopher Nitkin

Role: primary

Roa Rakesh

Role: primary

Role: backup

Sarvin Ghavam

Role: primary

Role: backup

Eugenia Pallotto

Role: primary

Ricardo J Rodriguez

Role: primary

Matthew Kielt

Role: primary

Role: backup

Elizabeth Foglia

Role: primary

Bradley Yoder

Role: primary

Bradley Yoder

Role: primary

Role: backup

Karen Hendrick-Munoz

Role: primary

Maher Shahroor

Role: primary

Amish Jain

Role: primary

Jonathan Wong

Role: primary

References

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Matlock DN, Ratcliffe SJ, Courtney SE, Kirpalani H, Firestone K, Stein H, Dysart K, Warren K, Goldstein MR, Lund KC, Natarajan A, Demissie E, Foglia EE. The Diaphragmatic Initiated Ventilatory Assist (DIVA) trial: study protocol for a randomized controlled trial comparing rates of extubation failure in extremely premature infants undergoing extubation to non-invasive neurally adjusted ventilatory assist versus non-synchronized nasal intermittent positive pressure ventilation. Trials. 2024 Mar 20;25(1):201. doi: 10.1186/s13063-024-08038-4.

Reference Type DERIVED
PMID: 38509583 (View on PubMed)

Other Identifiers

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849912

Identifier Type: -

Identifier Source: org_study_id

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