Assessment of Occult Lung Stress During Lung Protective Mechanical Ventilation

The present study will utilize esophageal manometry to measure the presence and magnitude of persistent patient effort during lung protective ventilation, allowing identification and mitigation of occult lung stress.

Inclusion Criteria:Intubated with a diagnosis of ARDS and expected to be ventilated for ≥ 48 hoursMeets Berlin criteria for ARDS, with or without underlying chronic lung diseaseTriggering breaths on the ventilatorTreating medical team agrees with patient participationExclusion Criteria:Known or suspected esophageal abnormalities, craniofacial abnormalities, or upper GI bleedShock that requires ≥ 2 vasopressorspH on arterial blood gas ≤7.25Minute ventilation ≥ 14L/minKnown or suspected pneumothorax, pneumomediastinum, and/or subcutaneous emphysemaSevere ARDS with P/F ratio <60PregnancyCurrently receiving extracorporeal membrane oxygenation (ECMO) therapyDecision to withhold life-sustaining treatmentPatients who are not expected to survive for 24 hoursLack of informed consent