Personalized Mechanical Ventilation Using Esophageal Pressure Monitoring in Morbidly Obese Adults with Moderate to Severe ARDS

What this Trial Is About

This research aims to evaluate a personalized approach to adjusting mechanical ventilator settings in morbidly obese patients with moderate to severe Acute Respiratory Distress Syndrome ARDS. The study focuses on whether using esophageal pressure measurements to guide ventilator settings leads to different and potentially better settings compared to a commonly used strategy in France. It addresses a specific need for patients with class III obesity BMI > 40 kgm2, who have distinct respiratory pressure characteristics affecting lung and chest wall mechanics. Participants will be monitored using a specialized nasogastric probe called the Nutrivent catheter, which measures esophageal and gastric pressures for several days while also allowing enteral nutrition. These pressure measurements, along with other respiratory signals from the ventilator, will be used to personalize ventilator settings, especially the positive end-expiratory pressure PEEP, to achieve slightly positive transpulmonary pressure at the end of expiration. This personalized strategy aims to optimize lung opening and avoid excessive lung inflation. During the study, participants will have continuous esophageal pressure monitoring through the catheter connected to the ventilator and data recording software. Researchers will assess how the personalized ventilator settings differ from standard care within the first 24 hours and monitor clinical outcomes such as oxygenation levels, mortality rates, days free from mechanical ventilation, and any complications like pneumothorax or hemodynamic issues. The study will include follow-up assessments up to 90 days, and participants safety and comfort will be closely observed throughout the trial.

Transpulmonary Pressure - Guided Mechanical Ventilation in Morbidly Obese ARDS Patients: a Feasibility Study.