Diaphragm Issues
Conditions
Keywords
Non-Invasive Phrenic Nerve Stimulation
Brief summary
The study is a prospective, multi-center, randomized, controlled study using adaptive design to assess the evidence of safety and performance of the STIMIT Activator 1 System in the treatment of patients who have been mechanically ventilated for up to 7 days and are predicted to require additional minimum 48 hours of mechanical ventilation or longer.
Detailed description
The objective of this clinical investigation is to evaluate the safety and effectiness of the STIMIT Activator 1 System in patients who are on invasive mechanical ventilation (MV) and thus are at risk of diaphragmatic dysfunction/atrophy. The study is expected to enroll 40 participants at up to 8 centers focusing on North American sites (main focus USA, \> 50% of study enrollment from US site). An interim analysis will be conducted after 30 participants have been enrolled and compelted their study follow-up to reconfirm sample size (adaptive design). Participants will be followed for up to 10 days or until they are successfully extubated (weaned) from mechanical ventilation, expire prior to extubation, or withdraw consent.
Interventions
DEVICEStimit Activator 1
The Stimit Activator 1 System will be used to stimulate the phrenic nerve resulting in diaphragm activation.
Sponsors
Stimit AG
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
An independent, blinded Core Lab will analyze the primary endpoint data.
Intervention model description
Prospective, multi-center, 1:1 randomized, controlled study using adaptive design
Eligibility
Sex/Gender
ALL
Age
21 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Are 21 years or older, and, 2. Have recently been placed on invasive MV (enroll and randomized as soon as possible after intubation), and have received no more than 7 days of MV 3. Are predicted to remain on mechanical ventilation for an additional 48 hours or longer post randomization
Exclusion criteria
1. Patients that are actively treated with continuous infusion of neuromuscular blocking agents beyond the enrollment period. 2. Medical condition known to affect the phrenic nerve or respiratory muscles (examples of possible medical conditions that could affect the phrenic nerve provided in Annex 1 below). 3. Any patients with ICP probe. 4. Patients with metallic device implants or body penetrating metallic devices in the upper body area within 30cm (12inches) from the coils; known anatomy or devices in the neck area (e.g., ECMO cannulas in the neck area, collars or cranial appliances) that would interfere with headset placement or stimulation. 5. Any non-removable electrical / electronic device (device internal or external) that may be prone to interaction with, or interference from the STIMIT Activator, such as pacemakers, implantable defibrillators, implanted medication pumps, bio-stimulators, deep brain stimulators, implanted nerve stimulator, deep brain stimulators or cochlear device implants. 6. BMI \>40. 7. Cardiogenic or septic shock with ongoing severe hemodynamic instability that cannot be stabilized within the enrollment period. 8. Physician thinks that the patient will not tolerate initial installation of the STIMIT respiratory sensor. 9. Anticipating withdrawal of life support and/or shift to palliation as the goal of care. 10. Known to be pregnant. 11. Participating in another clinical trial studying an experimental Intervention that could affect the study primary outcome. 12. Patients whose ultrasonographic assessment of right-sided diaphragmatic thickness would be too difficult (e.g. local subcutaneous emphysema surrounding the zone of apposition, large dressings in the zone of apposition that cannot be removed). 13. Patients with neck condition that would not allow placing the coils on the neck (e.g. open wounds that cannot be covered, skin at risk for burns). 14. Patients with significant spontaneous efforts (P0.1 \< - 2) that would not be at risk for diaphragmatic atrophy/ dysfunction.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Efffectiveness: Preservation of Diaphragm Thickness | Up to Day 10 | The intra-individual change in diaphragm thickness will be measured daily via ultrasound and compared between intervention and control groups. |
| Safety: Rate of device or procedure related serious adverse events (SAEs) | Up to Day 10 | Events will be collected for intervention group during the course of treatment. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Preservation of Diaphragm Thickness | Up to Day 3 | The intra-individual change in diaphragm thickness will be measured daily via ultrasound and compared between intervention and control groups. |
| Time to Rapid Shallow Breathing Index (RSBI) < 105 | Up to Day 10 | Time from intubation to RSBI\<105 breaths/min/L in days will be compared between intervention and control groups. |
| Maximum Inspiratory Pressure (MIP) at extubation | Up to Day 10 | MIP at extubation will be compared between intervention and control groups. |
Countries
Canada, United States
Contacts
Primary ContactTsiry Rabemahefa
Outcome results
None listed