The PNEUMA Trial

Partial Neuromuscular Blockage in Severe ARDS

Study Investigators

Dr. Ewan Goligher (ext. 6810, ewan.goligher@uhn.ca)

Dr. Jose Dianti (jose.dianti@gmail.com)

Study Contact

Jenna Wong (ext. 7613, jenna.wong@uhn.ca)

Study Summary

The PNEUMA Trial is a preliminary study that will try to demonstrate the safety and feasibility of achieving safe spontaneous breathing using partial neuromuscular blockade (NMB) in patients with severe ARDS who are receiving VV-ECMO.

Study Population

We plan to enroll 20 patients with severe ARDS receiving VV-ECMO. We will include patients already receiving NMB and patients who present injurious respiratory effort.

Study Objectives

To demonstrate the safety and feasibility of safe spontaneous breathing using partial NMB in severe ARDS patients supported on VV-ECMO.

Study Interventions

An esophageal balloon and a NAVA catheter will be placed. Once adequate sedation has been ensured, small boluses of cisatracurium will be administered. Then, an infusion of cisatracurium will be started to maintain spontaneous breathing at ∆Pes 3-10 cm H2O or selected Edi targets. After establishing a sedation and NMB dosing regimen at which safe spontaneous breathing is achieved, we will document whether these targets can be maintained over a 24-hour period.

Why it Matters

Controlling respiratory effort in patients with ARDS can be challenging, as they often exhibit a very high respiratory drive despite receiving high doses of sedatives. Consequently, these patients usually receive full neuromuscular blockade, with the goal to avoid such injurious respiratory efforts. Unfortunately, full neuromuscular blockade is not without complications. To address this issue, the use of partial neuromuscular blockade has been proposed as a strategy to maintain respiratory muscle activity while providing lung protective ventilation.