Grant: Project Grant

Each year almost 40,000 Canadians receive mechanical ventilation for a a diffuse inflammation of the lung caused by infection, flu or trauma and called acute respiratory distress syndrome (ARDS). Mortality is still unacceptably high >40% : this can be improved by making ventilation more protective for the lung. Mechanical Ventilation is indeed life-saving but, paradoxically, can cause further inflammation and injury in the remaining healthy lung. There is ample evidence that current mechanical ventilation is not sufficiently lung protective. We think we can provide a safer ventilation based on bedside measurements which we previously described to make ventilation non injurious and safe. Positive end expiratory pressure (PEEP) is one of the cornerstone of the treatment but it needs to be based of the lung response to pressure: we want to avoid exposing non responders to high pressure. We have designed a technique which can determine the individual response and the need for high or low pressure. Maximal distension of the lung is currently not well assessed at the bedside. We have described a technique using esophageal manometry to determine the distension of the most exposed regions of the lung, at higher risk of injury: this offers a limit for protection. We also showed that this distension can be used during spontaneous assisted breathing. We want to show that all these measures, which we call respiratory mechanics can feasibly and safely guide ventilator management and improves physiology. We want to perform a pilot randomized clinical trial (RCT) to assess the feasibility of our approach (Respiratory Mechanics-directed ventilator management), aand show it is safe (minimal signal for harm) and feasible.160 patients will be enrolled in 2 arms over 18 months. It will be compared to a standard protocolized approach. The results will inform a definitive study.