Goal Directed Mechanical Ventilation Aimed at Optimal Lung Compliance
Patients with acute respiratory failure exhibiting decreased respiratory system compliance with hypoxemia or carbon dioxide retention are often difficult to ventilate with current guidelines that limit applied plateau pressure Yet, these guidelines do not take into consideration chest wall mechanics. The investigators sought to determine whether partition of the respiratory system into its components by measuring esophageal pressure and thus assessment of pleural pressure, would help in patients with acute respiratory failure to identify the factors contributing to low respiratory system compliance.
|Study Design:||Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||Goal Directed Mechanical Ventilation Aimed at Optimal Lung Compliance Approach Guided by Esophageal Pressure in Acute Respiratory Failure.|
- Oxygenation [ Time Frame: 1 year ] [ Designated as safety issue: No ]
- lung compliance, expressed as ml/cmH2O. [ Time Frame: 1 year ] [ Designated as safety issue: No ]
|Study Start Date:||September 2012|
|Estimated Study Completion Date:||September 2013|
|Estimated Primary Completion Date:||September 2013 (Final data collection date for primary outcome measure)|
Esophageal balloon group
Esophageal balloon will be inserted, and esophageal pressure will be measured in patients with acute respiratory failure.
Intervention - PEEP and Inspiratory pressure will be adjusted according to the measured esophageal pressure.
Other: esophageal balloon
esophageal pressure as a surrogate for pleural pressure
Other Name: pleural pressure
Identifying the dominant factor affecting respiratory system compliance by measuring transpulmonary pressure may better direct and optimize mechanical ventilation. Thus, instead of limiting mechanical ventilation by plateau pressure, PEEP and Inspiratory pressure adjustment would be individualized specifically for each patient's lung compliance as indicated by transpulmonary pressure.
The main goal of this approach is to specifically target transpulmonary pressure instead of plateau pressure, and therefore achieve the best Lung compliance with the least transpulmonary pressure possible.
|Contact: Arie Soroksky, M.D.||firstname.lastname@example.org|
|Principal Investigator:||Arie Soroksky, MD||Wolfson MC|