Project 463182

In patients with lung failure and low oxygen levels, mechanical ventilation (the 'breathing machine') can be life-saving. However, mechanical ventilation can also injure the lung and the diaphragm (the main muscle of breathing), delaying recovery and increasing the risk of death and long-term disability. To prevent these injuries, we must avoid excessive pressure on the lung while also maintaining adequate patient breathing effort (to keep the diaphragm muscle in use). Achieving these targets during mechanical ventilation is difficult for a variety of reasons. The ventilator can easily take over breathing from the patient, and must be carefully adjusted to keep the patient breathing while avoiding dangerous pressures on the lung. Sedation used to keep the patient calm can take away the patient's drive to breathe and completely relax the breathing muscles. Patient breathing effort must be closely monitored, and techniques for this monitoring have only recently emerged. A whole new approach to setting the ventilator, to applying sedation, and to monitoring the patient's ventilation is required to prevent injury to both the lung and the diaphragm. We propose to test a new strategy to prevent injury to the lung and diaphragm during mechanical ventilation in patients with life-threatening lung failure. We will enroll 80 patients across several hospitals in a preliminary trial. Patients will be randomly assigned to usual care or to receive a specialized ventilation and sedation strategy that aims to avoid high pressures on the lung while keeping patients actively breathing at a comfortable effort level. This preliminary pilot trial will determine whether our research design for this clinical trial is feasible and will provide information on the most effective approaches to teaching and implementing the new strategy. It will also establish whether our strategy increases the chances of delivering safe and effective ventilation and sedation for these severely ill patients.