Project 466268

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, delaying recovery and increasing the risk of death and long-term disability. To prevent these injuries, doctors adjust the ventilator to try to minimize the volume of air inflating the lung with each breath. Research suggests that it would be more effective to minimize the pressure inflating the lung, rather than the volume. In patients with more severely injured lungs, avoiding high inflation pressures would further reduce the risk of lung damage and death. In patients with less severely injured lungs, higher inflation volumes could be permitted while avoiding high inflation pressures-this would prevent the need for heavy sedation and allow these patients to resume breathing, mobilize to regain strength, and potentially recover more quickly. This trial will test a simple strategy of avoiding high inflation pressures on the ventilator instead of avoiding high inflation volumes. The trial will be conducted across many intensive care units in Canada, the United States, Ireland, and Saudi Arabia. Patients will be randomly assigned to the best conventional approach to safe ventilation (avoiding high inflation volumes) or to receive a new approach to safe ventilation (avoiding high inflation pressures). The trial will establish whether the pressure-limiting approach can benefit patients by improving their chances of survival and accelerating recovery from lung failure.