Acute Respiratory Distress Syndrome Clinical Trial
Official title:
A RCT of Mechanical Ventilation, Directed by Esophageal Pressure Measurements, in Patients With Acute Lung Injury
The purpose of this study is to see whether esophageal pressure (PES) measurements will allow the investigators to choose the best method of mechanical ventilation in patients with acute lung injury (ALI).
The current standard of practice for ventilating patients with acute respiratory distress
syndrome (ARDS) is the ARDSnet protocol (N Engl J Med 2000; 342:1301-1308) which has been
shown to improve survival by limiting tidal volumes and thus preventing over distention of
the lungs. However, the lungs can also be damaged by under-inflation during mechanical
ventilation, and current practice ignores the effects of chest wall compression of the
lungs, which can cause under-inflation. The investigators have observed that a fraction of
critically ill patients with apparent ARDS have lung function abnormalities caused by
extrinsic compression which can be estimated by PES measurements. Changing ventilator
settings to apply normal physiological pressure to the lung has been beneficial in many such
patients. This protocol will formally test the clinical utility of PES measurements in
patients with ARDS.
This is a randomized controlled trial of therapy directed by esophageal balloon measurements
(PES) versus therapy directed by ARDSnet protocol, the current standard of care.
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