What is the optimal ventilation strategy lung protective ventilation, driving pressure-limited ventilation, and lung/diaphragm-protective ventilation and sedation strategies.?
Patient Type
Ventilated
INTERVENTION Type
Ventilation
GROUP A
• Lung Protective Ventilation Group: This is the standard care practice, involving limiting the air volumes delivered by the ventilator to prevent lung damage. Volumes are calculated based on your height and lung condition (4 to 6 ml/kg).
GROUP B
Limited Driving Pressure Ventilation Group: The focus here is on limiting the pressure on the lung alveoli. The ventilator will be adjusted by the team, emphasizing pressure indicators rather than volume based on height while maintaining good oxygenation.
INCLUSION CRITERIA
1. Intubated patients, not on ECLS, with low normalized respiratory elastance (<2.5 cm H2O/(ml/kg predicted body weight)) at the time of eligibility assessment
OR
2. Intubated patients, not on ECLS, with high normalized respiratory system elastance (≥2.5 cm H2O/(ml/kg predicted body weight)) at the time of eligibility assessment
INCLUSION TIME LIMIT
-
EXCLUSION CRITERIA
1. PaO2/FiO2 >300 mm Hg or (S/F >250, if PaO2/FiO2 has not been measured) at the time of randomization
2. Chronic hypercapnic respiratory failure defined as PaCO2>60mmHg in the outpatient setting
3. Home mechanical ventilation (non-invasive ventilation or via tracheotomy), not including nocturnal CPAP applied by nasal or face mask or home tracheotomy if not ventilated
4. Severe hypoxemia with PaO2/FiO2<80mmHg for >6 consecutive hours at the time of randomization
5. Severe hypercapnic respiratory failure with pH<7.25 and PaCO2>60mmHg for >6 consecutive hours at the time of randomization
6. Anticipated duration of mechanical ventilation is <48 hours from the time of screening
7. Duration of mechanical ventilation during current ICU admission is >72 hours
8. Previously diagnosed neuromuscular disorder
9. Current diagnosis of severe acute brain injury (e.g. ischemic or hemorrhagic stroke, traumatic brain injury) with Glasgow Coma Scale ≤ 8
10. Baseline weight prior to or at hospital admission less than 35 kilograms
11. Receiving extracorporeal life support without continuous invasive mechanical ventilatory support
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