Acute Respiratory Distress Syndrome, Ventilation Therapy; Complications
Conditions
Brief summary
The Lungpacer PROTECT Diaphragm Pacing Therapy System (DPTS) is a temporary, percutaneously-placed, transvenous, phrenic nerve-stimulating device intended to stimulate the diaphragm to preserve and improve inspiratory muscle strength in mechanically ventilated patients. The purpose of the PROTECT DPTS is to improve gas exchange, regional lung ventilation, and hemodynamics, and decrease atelectasis in patients presenting with acute respiratory distress syndrome (ARDS).
Detailed description
The PIRAT clinical study is intended to assess the feasibility, safety and effectiveness of transvenous phrenic-nerve-stimulating diaphragm pacing on clinical outcomes in mechanically ventilated patients. By delivering electrical stimulation to the phrenic nerves, which in turn causes the diaphragm muscle to contract, the PROTECT DPTS is intended to protect the diaphragm from atrophy and preserve lung mechanics to reduce lung inflammation and injury associated with short-term mechanical ventilation. Sustained lung and diaphragm health during early mechanical ventilation is expected to reduce the risk of comorbidities, improve clinical outcomes such as weaning success, and thereby reduce the number of patients who require prolonged mechanical ventilation.
Interventions
DEVICELungpacer PROTECT Diaphragm Pacing Therapy
PROTECT diaphragm pacing therapy is intended to stimulate the diaphragm to preserve and improve inspiratory muscle strength in mechanically ventilated patients.
Sponsors
Lungpacer Medical Inc.
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Are 18 years or older * Have been mechanically ventilated due to moderate ARDS for 48-120h * Have a PaO2/FiO2 ratio \< 200 and \> 100 at the time of screening with PEEP ≥ 5 cmH2O * Are expected to remain on mechanical ventilation ≥ 48 hours * Are under continuous sedation with Richmond Agitation Sedation Scale (RASS) ≤ -3
Exclusion criteria
* Septic shock with hemodynamic instability (norepinephrine or epinephrine \< 0.5 gamma/kg/min) * Catheter access to left subclavian vein deemed impossible * Use of neuromuscular blocking agents within last 12 hours * Bacteremia within the last 48 hours or uncontrolled source of infection * Currently on ECMO * Enrolled in any other study of an investigational drug or device, which may affect the outcomes of the current study * Pre-existing neurological, neuromuscular or muscular disorder that could affect the respiratory muscles * BMI \>45 kg/m2 * Known or suspected phrenic nerve paralysis * Any electrical device (implanted or external) that may be prone to interaction with or interference from the Lungpacer PROTECT DPTS, including neurological pacing/stimulator devices and cardiac pacemakers and defibrillators * No affiliation to the French health insurance system * Under curatorship * Imprisoned * Known or suspected to be pregnant or lactating
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Changes in PaO2/FiO2 ratio | Day 1 | The changes in PaO2/FiO2 ratio during each acute standard of care ventilation and acute PROTECT pacing therapy session. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Successful LIVE catheter placement | Day 1 | LIVE Catheter was successfully inserted into the left subclavian vein, positioned in accordance with the LIVE Catheter IFU, and the diaphragm was stimulated. |
| Alveolar-arterial (A-a) gradient | Day 1 | Alveolar-arterial (A-a) gradient documenting gas exchange during each acute standard of care ventilation and acute PROTECT pacing therapy session. |
| Cardiac output index | Day 1 | Pulse contour cardiac output index assessed by transpulmonary thermodilution during each acute standard of care ventilation and acute PROTECT pacing therapy session. |
| Regional lung atelectasis | Day 1 | Regional lung atelectasis assessed using electrical impedance tomography during each acute standard of care ventilation and acute PROTECT pacing therapy session. |
| Serious adverse events | Day 5 | Occurrence of pneumothorax, significant bleeding and desaturation serious adverse events. |
| Regional lung ventilation | Day 1 | Regional lung ventilation assessed using electrical impedance tomography during each acute standard of care ventilation and acute PROTECT pacing therapy session. |
Other
| Measure | Time frame |
|---|---|
| Days until successful weaning | Day 5 |
| Mortality | Day 5 |
Countries
France
Outcome results
None listed