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Trial registered on ANZCTR

Registration number
Ethics application status
Date submitted
Date registered
Date last updated
Type of registration
Prospectively registered

Titles & IDs
Public title
Diaphragm and limb muscle changes during intensive care
Scientific title
DiaphRAgm and SkeleTal muscle changes during Intensive Care: impact on patient functional outcomes
Secondary ID [1] 295878 0
Universal Trial Number (UTN)
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Diaphragm changes 309911 0
Musculoskeletal muscle changes 309914 0
Mechanical Ventilation 309915 0
Condition category
Condition code
Respiratory 308695 308695 0 0
Other respiratory disorders / diseases
Musculoskeletal 308696 308696 0 0
Other muscular and skeletal disorders

Study type
Description of intervention(s) / exposure
An ultrasound will be performed by the principle investigator, a physiotherapist, to assess the morphology, cross sectional area and thickness of the knee extensors (both limbs) and excursion thickness of the diaphragm muscle. The first baseline ultrasound examinations will be performed during the first 24-48 hours of mechanical ventilation (initial assessment). The first follow up will be at Day 5 of mechanical ventilation, then serial measures at Day 7, Day 10 and then weekly. A final examination will be performed up to 72 hours after extubation or liberation from mechanical ventilation for longer than 24 hours.
The following additional data will be collected on every participant (at the same intervals of diaphragm and skeletal muscle ultrasound) to calculate measures of lung function and nutritional status:
- nutritional parameters: feeding route, volume, product, energy and protein provided
- route and mode of mechanical ventilation
- Positive end expiratory pressure (PEEP) in cmH2O from the ventilator
Intervention code [1] 312582 0
Diagnosis / Prognosis
Comparator / control treatment
No control group
Control group

Primary outcome [1] 307669 0
Diaphragm measures of thickness and excursion (composite outcomes) will be collected using ultrasound. This will be achieved by recording still images using a curved probe sub-costally and a linear probe anterolaterally on the chest wall and using digital callipers to measure.
Timepoint [1] 307669 0
Within 24hrs of mechanical ventilation, then on Day 5, 7, 10 and weekly for up to 12 months or until liberation from mechanical ventilation. Diaphragm measurements will also be taken at the point of liberation from mechanical ventilation.
Primary outcome [2] 307670 0
Still images of the rectus femoris muscle will be taken with ultrasound using a linear probe. Composite outcomes of cross sectional area, fascicle length and pennation angle, thickness will be calculated using digital callipers
Timepoint [2] 307670 0
Collected within 24hrs of commencing mechanical ventilation, then on day 5, 7, 10 and weekly for up to 12 months or until liberation from mechanical ventilation. Rectus Femoris measurements will also be taken at the point of liberation from mechanical ventilation.
Secondary outcome [1] 352530 0
ICU acquired Weakness will be measured using the Medical Research Council sum score (MRC-SS). This is a measure of muscle strength (manual muscle test) of major muscle groups, with ICU acquired weakness defined as a score of less than 48/60.
Timepoint [1] 352530 0
Measured at two timepoints: the time of patient awakening and then discharge from ICU
Secondary outcome [2] 352531 0
The Chelsea Critical Care Physical Assessment Tool (CPAx).
This tool measures physical and respiratory function ranging from complete dependence to independent.
Timepoint [2] 352531 0
Measured at the time of patient awakening and at the time of discharge from ICU

Key inclusion criteria
1. Age >18 years
2. Anticipated treatment duration of mechanical ventilation (MV) for more than 48-hours.
Minimum age
18 Years
Maximum age
No limit
Both males and females
Can healthy volunteers participate?
Key exclusion criteria
Individuals with spinal cord injury, other primary neuromuscular diseases or new intracranial processes, amputations, previously wheelchair/bed bound, disseminated cancer and lower limb trauma. Body habitus preventing ultrasound imaging with >40 BMI

Study design
Purpose of the study
Allocation to intervention
Non-randomised trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Allocation is not concealed
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Not applicable
Masking / blinding
Blinded (masking used)
Who is / are masked / blinded?

The people administering the treatment/s
The people assessing the outcomes
Intervention assignment
Other design features
Single group
Not Applicable
Type of endpoint(s)
Statistical methods / analysis
Descriptive statistics are reported as mean and standard deviation (SD) or median and interquartile range (IQR) as appropriate. Changes over time for the ultrasound parameters will be examined using a linear random coefficient regression model. Within the model, an interaction between time and explanatory variables including age, sex, number of days in ICU at time of the first ultrasound measure, number of days on mechanical ventilation and ICU LOS will be examined. Pearson correlation coefficient will be used to assess bivariate relationships between ultrasonography and patient functional outcome measures. Coefficients will be interpreted as little (0.00-0.25), fair (0.25-0.50), moderate (0.50-0.75), and strong (0.75-1.0) association

Recruitment status
Not yet recruiting
Date of first participant enrolment
Date of last participant enrolment
Date of last data collection
Sample size
Accrual to date
Recruitment in Australia
Recruitment state(s)
Recruitment hospital [1] 12105 0
St Vincent's Hospital (Darlinghurst) - Darlinghurst
Recruitment postcode(s) [1] 24267 0
2010 - Darlinghurst

Funding & Sponsors
Funding source category [1] 300475 0
Name [1] 300475 0
St Vincent's Hospital Sydney - Professor Anthony Schembri
Address [1] 300475 0
390 Victoria Street
Darlinghurst NSW 2010
Country [1] 300475 0
Primary sponsor type
St Vincent's Hospital
390 Victoria Street
Darlinghurst NSW 2010
Secondary sponsor category [1] 299943 0
Name [1] 299943 0
Address [1] 299943 0
Country [1] 299943 0

Ethics approval
Ethics application status
Ethics committee name [1] 301277 0
St Vincent's Hospital HREC (EC00140)
Ethics committee address [1] 301277 0
St Vincent's Hospital Research Office Translational Research Centre 97-105 Boundary Street Darlinghurst 2010 NSW Sydney
Ethics committee country [1] 301277 0
Date submitted for ethics approval [1] 301277 0
Approval date [1] 301277 0
Ethics approval number [1] 301277 0

Brief summary
Hypothesis: Diagnostic ultrasound may be a useful non-invasive bedside tool to assist with detecting changes in diaphragm and skeletal muscle quantity and quality during mechanical ventilation and may have a relationship with patient functional outcomes on discharge from intensive care
Objectives: • To determine the rate and difference in wasting patterns between respiratory and peripheral muscle (as determined by ultrasound imaging).
• To determine if baseline ultrasound measurements can predict future patient outcomes such as ICU acquired weakness (ICUAW), Mechamical Ventilation (MV) time etc.
Study design: A single-centre prospective observational cohort trial of 62 critically ill patients in a tertiary referral hospital (St Vincent’s Hospital Sydney) in Australia.

Trial website
Trial related presentations / publications
Public notes

Principal investigator
Name 86458 0
Dr George Ntoumenopoulos
Address 86458 0
St Vincent's Hospital
Physiotherapy Department
390 Victoria Street
Darlinghurst NSW 2010
Country 86458 0
Phone 86458 0
Fax 86458 0
Email 86458 0
Contact person for public queries
Name 86459 0
Dr George Ntoumenopoulos
Address 86459 0
St Vincent's Hospital
Physiotherapy Department
390 Victoria Street
Darlinghurst NSW 2010
Country 86459 0
Phone 86459 0
Fax 86459 0
Email 86459 0
Contact person for scientific queries
Name 86460 0
Dr George Ntoumenopoulos
Address 86460 0
St Vincent's Hospital
Physiotherapy Department
390 Victoria Street
Darlinghurst NSW 2010
Country 86460 0
Phone 86460 0
Fax 86460 0
Email 86460 0

No information has been provided regarding IPD availability
Summary results
No Results