A Protocol Comparing Temporary Transvenous Diaphragm Pacing to Standard of Care for Weaning From Mechanical Ventilation

Inclusion Criteria: 1. Are 18 years or older, and, 2. Have been mechanically ventilated for ≥96 hours (4 days), and, 3. Have satisfied the Readiness-to-Wean criteria, and, 4. Have failed at least 2 weaning attempts (that were conducted at least 48 hours after initiation of MV, and, that were conducted on different calendar days, and, at least one of which was the protocol-specific Ventilator Liberation Trial). Exclusion Criteria: 1. MIP (absolute value) \>50 cm H2O; 2. Invasive mechanical ventilation \>90 days; 3. Currently on ECMO; 4. Weaning failure due to hypervolemia; 5. Medical history (including imaging) or known anatomy that prevents percutaneous insertion of the Catheter into the intended thoracic vein on the left side. 6. Clinically overt congestive heart failure that is preventing weaning; 7. Currently being treated with neuromuscular blockade; 8. Pre-existing neurological, neuromuscular or muscular disorder that could affect the respiratory muscles; 9. Pre-existing severe chronic pulmonary fibrosis; 10. Pleural effusions occupying greater than one third of the pleural space on either side; 11. BMI \>45 kg/m2; 12. Known or suspected phrenic nerve paralysis; 13. Any electrical device (implanted or external) that may be prone to interaction with, or interference from the Lungpacer DPTS including neurological pacing/stimulator devices, cardiac pacemakers and defibrillators; 14. Current hemodynamic instability, sepsis or septic shock; 15. Prior bacteremia reported within the last 48 hours; 16. Anticipating withdrawal of life support and/or shift to palliation as the goal of care; 17. Known or suspected to be pregnant or lactating; 18. Currently being treated in another clinical trial studying an experimental treatment that could affect the study primary outcome.