RT Journal Article
SR Electronic
T1 Late Breaking Abstract - Temporary Transvenous Diaphragm Neurostimulation in difficult-to-wean mechanically ventilated patients - Results of the RESCUE 2 randomized controlled trial
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 4352
DO 10.1183/13993003.congress-2020.4352
VO 56
IS suppl 64
A1 Martin Dres
A1 Marcelo Gama De Abreu
A1 Thomas Similowski
YR 2020
UL http://erj.ersjournals.com/content/56/suppl_64/4352.abstract
AB Mechanical ventilation (MV) may lead to ventilator-induced diaphragm dysfunction (VIDD). VIDD is associated with difficult MV weaning and longer MV duration. Mitigating VIDD may thus improve outcomes in patients on prolonged MV.We conducted a preliminary multicenter, open label, randomized controlled trial of temporary transvenous diaphragm neurostimulation (TTDN) using a multi-electrode stimulating central venous catheter (Lungpacer Diaphragm Pacing Therapy System) in difficult-to-wean MV patients.Patients on MV for >96 hours with at least two failed spontaneous breathing trials and satisfying readiness to wean criteria were randomized (1:1) to TTDN (up to 120 stimulations per day; up to 30 days) or standard of care (SoC). Outcomes assessed included the proportion of patients successfully weaned, MV duration, 30-day survival, and maximal inspiratory pressure (MIP).112 patients were randomized (57 TTDN; 55 SoC). TTDN was successfully delivered in 75% of cases. The frequency of serious adverse events was similar in both groups. For TTDN and SoC, respectively, the incidence of successful weaning was 82% and 74% (p=0.586); MV duration was 12.7±9.9 and 14.1±10.8 days (p=0.498); 30-day survival was 93% and 85% (p=0.216); MIP increased by 17±3 cmH2O vs. 5±2 cmH2O (p=0.001), with a significant stimulation dose-response relationship in TTDN patients.TTDN is feasible and safe in difficult to wean patients. A significant diaphragm-related improvement in MIP was achieved independent of patients' cooperation.This study will help define the patient population and effect size to appropriately power future studies for clinical efficacy.FootnotesCite this article as: European Respiratory Journal 2020; 56: Suppl. 64, 4352.This abstract was presented at the 2020 ERS International Congress, in session “Respiratory viruses in the "pre COVID-19" era”.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).