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Diaphragm Hibernation and Its Driving Factors in Mechanically Ventilated ICU Patients (DISSECT)

2026년 9월 14일 업데이트: Radboud University Medical Center

Diaphragm hIbernation and itS Driving factorS in mEChanically venTilated ICU Patients: the DISSECT Study

Rationale:

Patients with invasive mechanical ventilation (IMV) frequently develop diaphragm dysfunction and experience difficult weaning. Recent ex vivo work suggests that a subset of mechanically ventilated ICU patients may exhibit diaphragm hibernation, an energy conserving myosin state that reduces force generation and may lead to a reversible increase in diaphragm strength over time. However, it is unknown whether diaphragm hibernation can be demonstrated in vivo during IMV and which clinical and biological factors are associated with this phenotype.

Objective:

Primary objective is to determine the driving factors (biomarkers) of diaphragm hibernation during IMV. Secondary objectives are to determine the proportion of ventilated critically ill patients who exhibit diaphragm hibernation during IMV, to investigate inflammatory and metabolic factors and other clinical exposures associated with diaphragm hibernation, and to explore associations between diaphragm hibernation and weaning related and survival outcomes.

Study design:

Prospective, observational, longitudinal cohort study.

Study population:

Adult ICU patients receiving IMV, expected to remain mechanically ventilated for at least 72 hours.

Intervention (if applicable):

Not applicable. This is an observational study. Study specific procedures consist of repeated phrenic nerve magnetic stimulation and additional blood sampling.

Main study parameters/endpoints:

The primary study parameter is the proportion of participants exhibiting diaphragm hibernation during IMV. Diaphragm hibernation is defined as an increase in stimulated twitch tracheal pressure (Ptr,stim), a measure of diaphragm strength, of at least 10% relative to baseline (Day 0-1) at any follow up assessment (Day 2, 3, 5, or 7) obtained before extubation or death. Ptr,stim will be assessed repeatedly on Day 0-1, Day 2, Day 3, Day 5, and Day 7, or until extubation or death, whichever occurs first.

Nature and extent of the burden and risks associated with participation, benefit and group relatedness:

Participant burden is limited and mainly consists of repeated phrenic nerve magnetic stimulation during a ventilator delivered end expiratory occlusion and additional blood sampling of 9.5 mL per time point, up to a total of 47.5 mL across the study period. Magnetic stimulation is non-invasive and expected discomfort is transient. Rare transient physiological changes may occur and measurements are performed under continuous ICU monitoring and will be postponed or omitted if considered unsafe or interfering with clinical care. Direct benefit for participants is limited, but the study may provide clinically relevant knowledge on diaphragm hibernation and its driving factors. The research questions are specific to diaphragm physiology during IMV in critically ill patients, therefore the study is group related and cannot be performed in a different population.

연구 개요

상태

아직 모집하지 않음

정황

연구 유형

관찰

등록 (추정된)

112

연락처 및 위치

이 섹션에서는 연구를 수행하는 사람들의 연락처 정보와 이 연구가 수행되는 장소에 대한 정보를 제공합니다.

연구 연락처

이름: Jinyu Zhou, M.sc.
전화번호: 0031626194204
이메일: jinyu.zhou@radboudumc.nl

연구 장소

네덜란드
- Gelderland
  - Nijmegen, Gelderland, 네덜란드, 6525 GA
    - Radboud University Medical Center (Radboudumc)
    - 연락하다:
      
      Jonne Doorduin, PhD
      
      전화번호: 0031650155757
      
      이메일: jonne.doorduin@radboudumc.nl

참여기준

연구원은 적격성 기준이라는 특정 설명에 맞는 사람을 찾습니다. 이러한 기준의 몇 가지 예는 개인의 일반적인 건강 상태 또는 이전 치료입니다.

자격 기준

공부할 수 있는 나이

성인
고령자

건강한 자원 봉사자를 받아들입니다

아니

샘플링 방법

비확률 샘플

연구 인구

The study population consists of newly admitted adult ICU patients receiving invasive mechanical ventilation, in whom the first study assessment can be performed within 36 hours after initiation of IMV and who are expected to require IMV for at least 3 days.

설명

Inclusion Criteria:

Age ≥ 18 years.
Receiving invasive mechanical ventilation at screening.
Expected to remain mechanically ventilated for ≥ 72 hours from enrolment.
The first study assessment can be performed within 36 hours after initiation of invasive mechanical ventilation.

Exclusion Criteria:

Pre-existing neuromuscular disease affecting the diaphragm (e.g. motor neuron disease, myasthenia gravis, advanced muscular dystrophy, high cervical spinal cord injury) or use of neuromuscular blocker.
Known phrenic nerve palsy or prior diaphragmatic paralysis.
Long-term home mechanical ventilation (invasive or non-invasive) prior to ICU admission.
Post-operative patients after planned diaphragm or phrenic nerve surgery.
Contraindications to phrenic nerve magnetic stimulation (e.g., unstable cervical spine injury, uncontrolled intracranial hypertension, metallic implants in stimulation area as per manufacturer guidance).
Pregnancy.
Participation in another interventional trial that explicitly prohibits co-enrolment or is expected to substantially influence diaphragm function (e.g. experimental neuromuscular blocking strategies), as decided by the principal investigator.

공부 계획

이 섹션에서는 연구 설계 방법과 연구가 측정하는 내용을 포함하여 연구 계획에 대한 세부 정보를 제공합니다.

연구는 어떻게 설계됩니까?

디자인 세부사항

코호트 및 개입

그룹/코호트 그룹/코호트 생물 의학 또는 건강 결과에 대해 평가되는 관찰 연구의 참가자 그룹 또는 하위 그룹입니다.
Patients with expected > 3 days of invasive mechanical ventilation Patients expected > 3 days of invasive mechanical ventilation will be included in this study. Blood sample and diaphragm strength will be assessed repeatedly, until 7 days after initiation of invasive mechanical ventilation, extubation or death.

연구는 무엇을 측정합니까?

주요 결과 측정

결과 측정	측정값 설명	기간
Blood C reactive protein level 기간: C reactive protein will be assessed on Day 0-1, Day 2, Day 3, Day 5, and Day 7, or until extubation or death, whichever occurs first.	C reactive protein will be assessed by blood sample.	C reactive protein will be assessed on Day 0-1, Day 2, Day 3, Day 5, and Day 7, or until extubation or death, whichever occurs first.
Blood procalcitonin level 기간: Procalcitonin will be assessed on Day 0-1, Day 2, Day 3, Day 5, and Day 7, or until extubation or death, whichever occurs first.	Procalcitonin will be assessed by blood sample.	Procalcitonin will be assessed on Day 0-1, Day 2, Day 3, Day 5, and Day 7, or until extubation or death, whichever occurs first.
Blood metabolic biomarkers level 기간: Metabolic biomarkers will be assessed on Day 0-1, Day 2, Day 3, Day 5, and Day 7, or until extubation or death, whichever occurs first.	Metabolic biomarkers will be assessed by blood sample using OLINK Target 96 panel.	Metabolic biomarkers will be assessed on Day 0-1, Day 2, Day 3, Day 5, and Day 7, or until extubation or death, whichever occurs first.
Blood TNF-α level 기간: TNF-α will be assessed on Day 0-1, Day 2, Day 3, Day 5, and Day 7, or until extubation or death, whichever occurs first.	TNF-α will be assessed by blood sample.	TNF-α will be assessed on Day 0-1, Day 2, Day 3, Day 5, and Day 7, or until extubation or death, whichever occurs first.
Blood IL-10 level 기간: IL-10 will be assessed on Day 0-1, Day 2, Day 3, Day 5, and Day 7, or until extubation or death, whichever occurs first.	IL-10 will be assessed by blood sample.	IL-10 will be assessed on Day 0-1, Day 2, Day 3, Day 5, and Day 7, or until extubation or death, whichever occurs first.
Blood IL-8 level 기간: IL-8 will be assessed on Day 0-1, Day 2, Day 3, Day 5, and Day 7, or until extubation or death, whichever occurs first.	IL-8 will be assessed by blood sample.	IL-8 will be assessed on Day 0-1, Day 2, Day 3, Day 5, and Day 7, or until extubation or death, whichever occurs first.
Blood IL-6 level 기간: IL-6 will be assessed on Day 0-1, Day 2, Day 3, Day 5, and Day 7, or until extubation or death, whichever occurs first.	IL-6 will be assessed by blood sample.	IL-6 will be assessed on Day 0-1, Day 2, Day 3, Day 5, and Day 7, or until extubation or death, whichever occurs first.
Blood ferritin level 기간: Ferritin will be assessed on Day 0-1, Day 2, Day 3, Day 5, and Day 7, or until extubation or death, whichever occurs first.	Ferritin will be assessed by blood sample.	Ferritin will be assessed on Day 0-1, Day 2, Day 3, Day 5, and Day 7, or until extubation or death, whichever occurs first.

2차 결과 측정

결과 측정	측정값 설명	기간
Proportion of participants exhibiting diaphragm hibernation during invasive mechanical ventilation 기간: Ptr,stim will be assessed repeatedly on Day 0 to 1, Day 2, Day 3, Day 5, and Day 7, or until extubation or death, whichever occurs first.	Diaphragm hibernation is defined as an increase in stimulated twitch tracheal pressure (Ptr,stim), a measure of diaphragm strength, of at least 10% relative to baseline (Day 0 to 1) at any follow up assessment (Day 2, 3, 5, or 7) obtained before extubation or death.	Ptr,stim will be assessed repeatedly on Day 0 to 1, Day 2, Day 3, Day 5, and Day 7, or until extubation or death, whichever occurs first.
Number of days from intubation to successful extubation 기간: Collected from study inclusion until Day 28, or ICU/hospital discharge or death, whichever occurs first	Data about number of days from intubation to successful extubation will be retrieved from electronic medical records.	Collected from study inclusion until Day 28, or ICU/hospital discharge or death, whichever occurs first
Number of days from first SBT to successful extubation 기간: Collected from study inclusion until Day 28, or ICU/hospital discharge or death, whichever occurs first	Data about number of days from first SBT to successful extubation will be retrieved from electronic medical records.	Collected from study inclusion until Day 28, or ICU/hospital discharge or death, whichever occurs first
Incidence of weaning failure 기간: Collected from study inclusion until Day 28, or ICU/hospital discharge or death, whichever occurs first	Weaning failure is defined as SBT failure or reintubation within 48 hours. Data will be retrieved from electronic medical records.	Collected from study inclusion until Day 28, or ICU/hospital discharge or death, whichever occurs first
ICU length of stay 기간: Collected from study inclusion until Day 28, or ICU discharge or death, whichever occurs first	Data about ICU length of stay will be retrieved from electronic medical records.	Collected from study inclusion until Day 28, or ICU discharge or death, whichever occurs first
Hospital length of stay 기간: Collected from study inclusion until Day 28, or hospital discharge or death, whichever occurs first	Data about hospital length of stay will be retrieved from electronic medical records.	Collected from study inclusion until Day 28, or hospital discharge or death, whichever occurs first
ICU mortality 기간: Collected from study inclusion until Day 28, or ICU discharge or death, whichever occurs first	Data about ICU mortality will be retrieved from electronic medical records.	Collected from study inclusion until Day 28, or ICU discharge or death, whichever occurs first
Hospital mortality 기간: Collected from study inclusion until Day 28, or hospital discharge or death, whichever occurs first	Data about hospital mortality will be retrieved from electronic medical records.	Collected from study inclusion until Day 28, or hospital discharge or death, whichever occurs first
Day 28 all-cause mortality 기간: Collected from study inclusion until Day 28 or death, whichever occurs first	Data about day 28 all-cause mortality will be retrieved from electronic medical records.	Collected from study inclusion until Day 28 or death, whichever occurs first
ICU-free days through day 28 기간: Collected from ICU discharge until Day 28 or death, whichever occurs first	Data about ICU-free days through day 28 will be retrieved from electronic medical records.	Collected from ICU discharge until Day 28 or death, whichever occurs first
Hospital-free days through day 28 기간: Collected from hospital discharge until Day 28 or death, whichever occurs first	Data about hospital-free days through day 28 will be retrieved from electronic medical records.	Collected from hospital discharge until Day 28 or death, whichever occurs first
Time to ICU discharge alive through day 28 기간: Collected from study inclusion until Day 28, or ICU discharge or death, whichever occurs first	Data about time to ICU discharge alive through day 28 will be retrieved from electronic medical records.	Collected from study inclusion until Day 28, or ICU discharge or death, whichever occurs first
Time to hospital discharge alive through day 28 기간: Collected from study inclusion until Day 28, or hospital discharge or death, whichever occurs first	Data about time to hospital discharge alive through day 28 will be retrieved from electronic medical records.	Collected from study inclusion until Day 28, or hospital discharge or death, whichever occurs first

공동 작업자 및 조사자

여기에서 이 연구와 관련된 사람과 조직을 찾을 수 있습니다.

스폰서

Radboud University Medical Center

수사관

수석 연구원: Jonne Doorduin, PhD, Radboud University Medical Centre (Radboudumc)
연구 의자: Leo Heunks, M.D., PhD, Radboud University Medical Centre (Radboudumc)

연구 기록 날짜

이 날짜는 ClinicalTrials.gov에 대한 연구 기록 및 요약 결과 제출의 진행 상황을 추적합니다. 연구 기록 및 보고된 결과는 공개 웹사이트에 게시되기 전에 특정 품질 관리 기준을 충족하는지 확인하기 위해 국립 의학 도서관(NLM)에서 검토합니다.

연구 주요 날짜

연구 시작 (추정된)

2026년 10월 1일

기본 완료 (추정된)

2028년 9월 1일

연구 완료 (추정된)

2028년 12월 1일

연구 등록 날짜

최초 제출

2026년 9월 9일

QC 기준을 충족하는 최초 제출

2026년 9월 14일

처음 게시됨 (실제)

2026년 9월 15일

연구 기록 업데이트

마지막 업데이트 게시됨 (실제)