Using Transpulmonary Pressure-Guided Mechanical Ventilation to Protect the Right Ventricle in Adults with Moderate to Severe Pneumonia-Induced ARDS

What this Trial Is About

Researchers are evaluating a transpulmonary pressure-guided mechanical ventilation strategy to see if it can better protect the right ventricle of the heart, especially by reducing the occurrence of acute cor pulmonale ACP, in patients with moderate to severe acute respiratory distress syndrome ARDS caused by pneumonia. This study compares this approach to the commonly used right ventricular protective mechanical ventilation strategy. The goal is to improve outcomes by tailoring ventilation settings based on transpulmonary pressure measurements. Participants are assigned to one of two groups. In the transpulmonary pressure group, patients receive individualized positive end-expiratory pressure PEEP settings guided by esophageal pressure monitoring, with tidal volume adjusted to maintain specific transpulmonary pressure targets and adjusted respiratory parameters to keep oxygenation and pH within set ranges. The control group receives ventilation based on a low PEEPFiO2 table method with volume-assist control ventilation, maintaining tidal volume around 6 mLkg predicted body weight and plateau pressure limits, but without adjusting based on transpulmonary pressure measurements. Both groups have esophageal pressure monitoring, but only the experimental group uses it to guide ventilation settings. Throughout the study, participants undergo invasive mechanical ventilation with detailed monitoring of respiratory parameters and right ventricular involvement over 28 days. Researchers measure the incidence of right ventricular issues as the primary outcome. The study runs from March 2026 to December 2028, with participants monitored closely during treatment to assess heart and lung function. Safety and treatment effects are carefully tracked to compare the two ventilation strategies.

Transpulmonary Pressure-guided Mechanical Ventilation Strategy in Right Ventricular Protection in Patients With ARDS