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Updated: Sep 16, 2025
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Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome ARDS
Published on: April 7, 2021
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Utilizing Indirect Intrapleural Pressure to Guide Mechanical Ventilation in Burn Patients With ARDS
Amanda M Soo Ping Chow1,2, Laura S Johnson3,4, Tuan D Le1
1Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC 20010, United States.
Summary
Esophageal pressure monitoring (Pes) guided ventilator management in severe burn patients with acute respiratory distress syndrome (ARDS). This approach improved oxygenation and allowed for higher positive end-expiratory pressure (PEEP) settings.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Burn Surgery
Background:
- Severe burn injuries significantly increase the risk of developing acute respiratory distress syndrome (ARDS).
- Current ARDS management protocols often overlook the unique lung dynamics in burn patients.
- Esophageal pressure monitoring (Pes) offers potential for optimizing ventilator settings but is understudied in burn populations.
Purpose of the Study:
- To investigate the utility of esophageal pressure monitoring (Pes) in guiding ventilator management for burn patients with ARDS.
- To assess the impact of Pes on ventilator adjustments, specifically positive end-expiratory pressure (PEEP).
- To evaluate changes in oxygenation parameters following the initiation of Pes-guided ventilation.
Main Methods:
- Retrospective review of burn patients diagnosed with ARDS (Berlin definition) who underwent Pes monitoring.
- Analysis of ventilator settings (PEEP) and oxygenation indices (PaO2/FiO2 ratio and OI) before and after Pes initiation.
- Data collected at 1, 3, and 5-day intervals post-Pes monitoring.
Main Results:
- Patients required increased PEEP levels after Pes initiation (12 to 17 cmH2O).
- PaO2/FiO2 ratios significantly improved by day 5 post-Pes monitoring compared to baseline.
- Oxygenation Index (OI) showed no significant change between pre- and 5-day post-Pes monitoring.
Conclusions:
- Esophageal pressure monitoring (Pes) can guide ventilator management in burn patients with ARDS.
- This strategy may facilitate PEEP titration to improve oxygenation while managing lung mechanics.
- Further research is warranted to fully elucidate the role of Pes in this patient cohort.
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