LANDMARK
Lung and Diaphragm-Protective Ventilation by Means of Assessing Respiratory Work
Study Investigators
Dr. Jose Dianti (jose.dianti@uhn.ca)
Dr. Ewan Goligher (ext. 6810, ewan.goligher@uhn.ca)
Dr. Niall Ferguson
Study Contact
Jenna Wong (ext. 7613, jenna.wong@uhn.ca)
Samira Fard (samira.fard@uhn.ca)
Study Summary
A clinical trial of a novel approach to mechanical ventilation designed to protect both the lung and diaphragm injury.
Study Population
Mechanically ventilated patients with acute hypoxemic respiratory failure (P/F ratio < 300 mm Hg) who will require mechanical ventilation for at least 24 hours (n=40) including 10 patients receiving venovenous extracorporeal life support.
Study Objectives
Determine the feasibility of achieving lung and diaphragm-protective ventilation.
Assess the effect of higher PEEP and extracorporeal CO2 removal on lung and diaphragm-protective ventilation.
Develop an artificial intelligence-based model for guiding mechanical ventilation to achieve lung and diaphragm-protective ventilation targets.
Study Interventions
Patients will be monitored using esophageal pressure and electrical impedance tomography. The study team (including MD and RRT) will titrate mechanical ventilation settings and sedation to achieve lung and diaphragm-protective ventilation targets (based on esophageal and transpulmonary pressures). The effect of two levels of PEEP and varying extracorporeal CO2 removal (in ECLS patients) on feasibility of study targets will be assessed. We will aim to determine whether ventilation can be maintained within study targets over 24 hours.
Why it Matters
Lung and diaphragm injury are common during mechanical ventilation and substantially increase the risk of death, prolonged ICU admission, and long-term functional disability. Lung-protective ventilation can improve outcomes; it’s unknown whether diaphragm-protective ventilation can also improve outcomes. This first-ever study of diaphragm-protective ventilation will provide insights on how best to deliver lung and diaphragm-protective ventilation in a future multicenter clinical trial.