BEST (Burn Center Evaluation of Standard Therapies) Ventilator Mode Study-

• Ventilator-free Days During the First 28 Days [ Time Frame: 28 days ] [ Designated as safety issue: No ]
  The primary end point was ventilator-free days in the first 28 days, defined as the number of days after randomization from day 0 to day 28 alive without ventilator assistance for at least 48 consecutive hrs.
  
  

• Days Free From Nonpulmonary Organ Failure [ Time Frame: 28 ] [ Designated as safety issue: No ]
  days free from nonpulmonary organ failure as adapted from the ARDSnet study in the first 28 days.
  
  
• Death [ Time Frame: during hospitalization ] [ Designated as safety issue: Yes ]
  In-hospital death.
  
  
• Ventilator Associated Pneumonia [ Time Frame: 28 days ] [ Designated as safety issue: Yes ]
  Those who develop both clinical and microscopic evidence of pulmonary infection while on the ventilator.
  
  
• Need for Rescue Ventilator [ Time Frame: 28 days ] [ Designated as safety issue: Yes ]
  Subjects who did not meet predetermined oxygenation and ventilation goals on the study mode despite ventilator- specific optimization were switched to a rescue mode of ventilation.
  
  
• Barotrauma [ Time Frame: 28 days ] [ Designated as safety issue: Yes ]
  Defined as a new pneumothorax, pneumomediastinum, subcutaneous emphysema, interstitial emphysema, or pneumatocele >2 cm in diameter not associated with a vascular procedure, lung biopsy, or thoracentesis.
  
  
• Ventilator Associated Tracheobronchitis (VATB) [ Time Frame: checked daily ] [ Designated as safety issue: Yes ]
  Defined as carinal or mainstem airway friability and sloughing with associated bleeding. Only diagnosed after the patient had spent at least 7 days on the assigned ventilator mode and had not been diagnosed with inhalation injury on admission
  
  

This is a prospective, randomized, controlled trial comparing HFPV to conventional ventilator modes in the support of burn patients with respiratory failure. Burn patients who develop the need for mechanical ventilation present a variety of challenges that call for innovative therapeutic options. Even in the absence of smoke inhalation injury,decreased chest wall compliance from full thickness burns as well as massive fluid requirements are just a few variables that make it difficult to achieve gas exchange goals when attempting to apply conventional lung protective strategies recommended by the ARDS Net investigators.