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Hernia, DIaphragmatic, CongenitalNAVA-DIAPHNCT03250793

Work of Breathing Description in Neonates With Congenital Diaphragmatic Hernia in NAVA and in Conventional Ventilation.

A study testing Physiologic study measuring work of breathing which can be estimated by the esophageal and trans-diaphragmatic pressure-time product obtained by an esophageal transducer in people with Hernia, DIaphragmatic, Congenital, run by Hospices Civils de Lyon at 1 site in France.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

Congenital diaphragmatic hernia (CDH) is a congenital malformation associated with significant mortality and respiratory morbidity, particularly related to prolonged mechanical ventilation. Read more about this study

Who is it for?
Ages 1 year and older
Conditions the study is for
Hernia, DIaphragmatic, Congenital
What is being tested?
Physiologic study measuring work of breathing which can be estimated by the esophageal and trans-diaphragmatic pressure-time product obtained by an esophageal transducer
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
8 participants
Where
1 siteFrance
Study dates
20 Aug 2018to 20 Jan 2021
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 1 year and older
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Neonate admitted to neonatal intensive care beyond 34 weeks of amenorrhea
  • With a diagnosis of congenital diaphragmatic hernia having undergone a repair surgery.
  • Necessary invasive ventilatory support by conventional ventilation
  • Informed and signed consent of parents (and / or holders of parental authority)

Who cannot join

  • Refusal of parents (and / or holders of parental authority) to participate in the study
  • Contra-indication to the use of an oro or naso-gastric tube (oesophageal surgery)
  • Child at risk of poor tolerance to the placement of the oesophageal pressure transducer (history of discomfort when placing a tube, weight <1500g)
  • Central or neuromuscular neurological pathology which may affect respiratory control

Trial locations and contacts

1 site in 1 country.

France1 site
  • Service de Réanimation Néonatale- Hôpital Femme Mère Enfant- Hospices Civils de Lyon

    Bron, 69500

Other trials in France

About this study

Official title: Physiologic Pilot Study: Work of Breathing Description in Neonates With Congenital Diaphragmatic Hernia in Post-surgical Period Alternatively in Conventional Ventilation (Pressure Controlled) and in NAVA (Neurally Adjusted Ventilatory Assist) Ventilation.

Congenital diaphragmatic hernia (CDH) is a congenital malformation associated with significant mortality and respiratory morbidity, particularly related to prolonged mechanical ventilation. NAVA (Neurally Adjusted Ventilatory Assist) is a recent technique that uses the recognition of the electrical activity of the patient's diaphragm (Edi) and delivers a synchronized proportional assisted ventilation. This technique has already been used in the newborn, especially premature and has shown many benefits. Only one study in the literature shows its feasibility in newborns with CDH. This technique seems interesting in the context of CDH because it would limit baro-trauma and improve synchronization. Before demonstrating the clinical benefits, it seems important to describe the effects on the respiratory physiology, in particular on work of breathing which can be estimated by the esophageal and trans-diaphragmatic pressure-time product obtained by an esophageal transducer. Our study is an innovative physiologic pilot study with the objective to describe work of breathing in neonates with CDH in post-surgical period in NAVA ventilation and in conventional ventilation using an esophageal transducer. It will provide the clinician with a physiological justification for the use of NAVA to rapidly improve the respiratory muscular dynamics of these patients. This study is a prerequisite for the realization of studies demonstrating the clinical benefit of NAVA ventilation on reduction of duration of ventilation and more generally on morbidity and mortality in the population of neonate with CDH.

Being tested
Physiologic study measuring work of breathing which can be estimated by the esophageal and trans-diaphragmatic pressure-time product obtained by an esophageal transducer
Keywords
Hernia, DIaphragmatic, Congenital, Respiration, Artificial, physiologic pilot study, NAVA, Neurally Adjusted Ventilatory Assist, esophageal transducer, Work of Breathing
Medical subject headings
Hernia, Diaphragmatic, Respiratory Aspiration

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Physiologic study measuring work of breathing which can be estimated by the esophageal and trans-diaphragmatic pressure-time product obtained by an esophageal transducerDevice

    While the patient is under respiratory assistance on the SERVO-I respirator, he will be included in the study and one esophageal transducer of 2,3 mm of diameter will be inserted through the mouth / nose in addition to NAVA's naso / Oro-Gastric tube( Edi Catheter, 6Fr, 49 cm, PHT free 5 pcs / pkg or Catheter Edi, 6Fr, 50 cm, PHT free 5 pcs / pkg). Measurements will be performed using the esophageal transducer under two conditions: 2 hours in conventional ventilation (pressure controlled), 2 hours in NAVA ventilation and then again 2 hours in conventional ventilation (PC) for a total duration of 6 hours.The parameters of conventional ventilation will be left free at the choice of the neonatologist and will be identical between the two periods of conventional ventilation. The initial NAVA level will be defined by the neonatologist using pre-visualization curves. All signals will be recorded via an amplification and acquisition system. Values will be averaged over 100 cycles.

Study groups in NCT03250793
Study groupRoleWhat they receive
Neonate with congenital diaphragmatic herniaExperimentalNeonates with congenital diaphragmatic hernia in post-surgical period under mechanical ventilation during weaning of mechanical ventilation
Receives: Device: Physiologic study measuring work of breathing which can be estimated by the esophageal and trans-diaphragmatic pressure-time product obtained by an esophageal transducer

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Work of breathing averaged over 100 consecutive cycles in NAVA ventilation and conventional ventilation

    Work of breathing is estimated by the esophageal and trans-diaphragmatic pressure-time product obtained by an esophageal transducer

    Measured: in post-surgical period during 6 hours

Secondary outcomes (30)
  1. Patient-ventilator synchronization in NAVA

    Comparison of the asynchrony indexes between the 2 modes (Number of asynchronies / Number of respiratory cycles)

    Measured: through study completion, an average of 1 year

  2. Patient-ventilator synchronization in conventional ventilation

    Comparison of the asynchrony indexes between the 2 modes (Number of asynchronies / Number of respiratory cycles)

    Measured: through study completion, an average of 1 year

  3. Dynamic hyperinflation (intrinsic PEEP) in NAVA

    Intrinsic PEEP average over 100 cycles

    Measured: through study completion, an average of 1 year

  4. Dynamic hyperinflation (intrinsic PEEP) in conventional ventilation.

    Intrinsic PEEP average over 100 cycles

    Measured: through study completion, an average of 1 year

  5. Ventilation parameters: peak inspiratory pressure in NAVA

    Evolution of the following parameters: peak inspiratory pressure, mean pressure, tidal volume, Ti / Ttot ration, FiO2

    Measured: through study completion, an average of 1 year

  6. Ventilation parameters: mean pressure in NAVA

    Evolution of the following parameters: peak inspiratory pressure, mean pressure, tidal volume, Ti / Ttot ration, FiO2

    Measured: through study completion, an average of 1 year

  7. Ventilation parameters: tidal volume in NAVA

    Evolution of the following parameters: peak inspiratory pressure, mean pressure, tidal volume, Ti / Ttot ration, FiO2

    Measured: through study completion, an average of 1 year

  8. Ventilation parameters: Ti / Ttot ratio in NAVA

    Evolution of the following parameters: peak inspiratory pressure, mean pressure, tidal volume, Ti / Ttot ration, FiO2

    Measured: through study completion, an average of 1 year

  9. Ventilation parameters: FiO2 in NAVA

    Evolution of the following parameters: peak inspiratory pressure, mean pressure, tidal volume, Ti / Ttot ration, FiO2

    Measured: through study completion, an average of 1 year

  10. Ventilation parameters: peak inspiratory pressure in conventional ventilation

    Evolution of the following parameters: peak inspiratory pressure, mean pressure, tidal volume, Ti / Ttot ration, FiO2

    Measured: through study completion, an average of 1 year

  11. Ventilation parameters: mean pressure in conventional ventilation

    Evolution of the following parameters: peak inspiratory pressure, mean pressure, tidal volume, Ti / Ttot ration, FiO2

    Measured: through study completion, an average of 1 year

  12. Ventilation parameters: tidal volume in conventional ventilation

    Evolution of the following parameters: peak inspiratory pressure, mean pressure, tidal volume, Ti / Ttot ration, FiO2

    Measured: through study completion, an average of 1 year

  13. Ventilation parameters: Ti / Ttot ratio in conventional ventilation

    Evolution of the following parameters: peak inspiratory pressure, mean pressure, tidal volume, Ti / Ttot ration, FiO2

    Measured: through study completion, an average of 1 year

  14. Ventilation parameters: FiO2 in conventional ventilation

    Evolution of the following parameters: peak inspiratory pressure, mean pressure, tidal volume, Ti / Ttot ration, FiO2

    Measured: through study completion, an average of 1 year

  15. Physiological parameters indirectly evaluating work of breathing: esophageal swing in NAVA

    Averages of the esophageal and diaphragmatic swings over 100 cycles in each period. Esophageal and diaphragmatic swings are physiological parameters obtained by the esophageal transducer which expressed muscle strength.

    Measured: through study completion, an average of 1 year

  16. Physiological parameters indirectly evaluating work of breathing: diaphragmatic swing in NAVA

    Averages of the esophageal and diaphragmatic swings over 100 cycles in each period. Esophageal and diaphragmatic swings are physiological parameters obtained by the esophageal transducer which expressed muscle strength.

    Measured: through study completion, an average of 1 year

  17. Physiological parameters indirectly evaluating work of breathing: esophageal swing in conventional ventilation

    Averages of the esophageal and diaphragmatic swings over 100 cycles in each period. Esophageal and diaphragmatic swings are physiological parameters obtained by the esophageal transducer which expressed muscle strength.

    Measured: through study completion, an average of 1 year

  18. Physiological parameters indirectly evaluating work of breathing: diaphragmatic swing in conventional ventilation

    Averages of the esophageal and diaphragmatic swings over 100 cycles in each period. Esophageal and diaphragmatic swings are physiological parameters obtained by the esophageal transducer which expressed muscle strength.

    Measured: through study completion, an average of 1 year

  19. Clinical parameters of neonates: respiratory rate in NAVA

    Evolution of clinical parameters (respiratory rate, heart rate, blood pressure) at the beginning and end of each period

    Measured: through study completion, an average of 1 year

  20. Clinical parameters of neonates: heart rate in NAVA

    Evolution of clinical parameters (respiratory rate, heart rate, blood pressure) at the beginning and end of each period

    Measured: through study completion, an average of 1 year

  21. Clinical parameters of neonates: blood pressure in NAVA

    Evolution of clinical parameters (respiratory rate, heart rate, blood pressure) at the beginning and end of each period

    Measured: through study completion, an average of 1 year

  22. Clinical parameters of neonates: respiratory rate in conventional ventilation

    Evolution of clinical parameters (respiratory rate, heart rate, blood pressure) at the beginning and end of each period

    Measured: through study completion, an average of 1 year

  23. Clinical parameters of neonates: heart rate in conventional ventilation

    Evolution of clinical parameters (respiratory rate, heart rate, blood pressure) at the beginning and end of each period

    Measured: through study completion, an average of 1 year

  24. Clinical parameters of neonates: blood pressure in conventional ventilation

    Evolution of clinical parameters (respiratory rate, heart rate, blood pressure) at the beginning and end of each period

    Measured: through study completion, an average of 1 year

  25. Gas exchange: measurement of transcutaneous SaO2 in NAVA

    Evolution of oxygenation parameters (SpO2) and transcutaneous CO2 (pCO2) during each period. SpO2 and pCO2 are measured continuously; average and median will be valued in each period of the study. No blood test will be required.

    Measured: through study completion, an average of 1 year

  26. Gas exchange: measurement of transcutaneous pCO2 in NAVA

    Evolution of oxygenation parameters (SpO2) and transcutaneous CO2 (pCO2) during each period. SpO2 and pCO2 are measured continuously; average and median will be valued in each period of the study. No blood test will be required.

    Measured: through study completion, an average of 1 year

  27. Gas exchange: measurement of transcutaneous pCO2 in conventional ventilation

    Evolution of oxygenation parameters (SpO2) and transcutaneous CO2 (pCO2) during each period. SpO2 and pCO2 are measured continuously; average and median will be valued in each period of the study. No blood test will be required.

    Measured: through study completion, an average of 1 year

  28. Gas exchange: measurement of transcutaneous SaO2 in conventional ventilation

    Evolution of oxygenation parameters (SpO2) and transcutaneous CO2 (pCO2) during each period. SpO2 and pCO2 are measured continuously; average and median will be valued in each period of the study. No blood test will be required.

    Measured: through study completion, an average of 1 year

  29. Neonate comfort scores: COMFORT-BEHAVIOR score in NAVA

    Evaluation of comfort (COMFORT-BEHAVIOR scale) at the beginning and at the end of each period.

    Measured: through study completion, an average of 1 year

  30. Neonate comfort scores: COMFORT-BEHAVIOR score in conventional ventilation

    Evaluation of comfort (COMFORT-BEHAVIOR scale) at the beginning and at the end of each period.

    Measured: through study completion, an average of 1 year

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted16 Aug 2017
  2. Study start20 Aug 2018
  3. Primary completion20 Jan 2021
  4. Study completion20 Jan 2021

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Other
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
8 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03250793
Sponsor's protocol ID
69HCL17_0429
Other IDs
2017-A02270-53
Acronym
NAVA-DIAPH
Status last verified
Aug 2025
First submitted
3 Aug 2017
Last updated
4 Sep 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Dreyfus L, Butin M, Plaisant F, Claris O, Baudin F. Respiratory physiology during NAVA ventilation in neonates born with a congenital diaphragmatic hernia: The "NAVA-diaph" pilot study. Pediatr Pulmonol. 2023 May;58(5):1542-1550. doi: 10.1002/ppul.26357. Epub 2023 Mar 1.

    PubMed 36807570

Questions about this trial

What is this clinical trial studying?

A study testing Physiologic study measuring work of breathing which can be estimated by the esophageal and trans-diaphragmatic pressure-time product obtained by an esophageal transducer in people with Hernia, DIaphragmatic, Congenital, run by Hospices Civils de Lyon at 1 site in France.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 4 Sep 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in France. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Work of breathing averaged over 100 consecutive cycles in NAVA ventilation and conventional ventilation (time frame: in post-surgical period during 6 hours). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03250793, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Sep 2025.

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