Careful Ventilation in Acute Respiratory Distress Syndrome. The CAVIARDS study

Each year almost 40,000 Canadians receive mechanical ventilation for a a diffuse inflammation of the lung caused by bacterial infection, flu or trauma and called acute respiratory distress syndrome (ARDS). The most recent and specific cause of admission to an ICU has been COVID-19 which caused hundreds thousand cases in Canada. As shown by the pandemic, mortality under mechanical ventilation is still unacceptably high, often >40% : clinicians are still struggling about the best way to deliver mechanical ventilation. We think the prognosis can be improved by making ventilation more protective for the lung. Mechanical Ventilation is indeed life-saving but, paradoxically, can cause further inflammation and damage in the remaining healthy lung and in the whole body. Current mechanical ventilation is often not sufficiently lung protective. We think that the use of bedside measurements that we previously described can make ventilation less injurious, safer and that it will improve survival. Positive pressure is one of the cornerstone of the treatment but we propose to adjust it based of the individual lung response to pressure using a technique that we designed: this differentiate responders to high pressure vs. non responders. For the first time, pressure applied with mechanical ventilation will be individualized. We also showed how to monitor and control the degree of spontaneous ventilation in conjonction with the ventilator and which should be facilitated for the patient. We believe that these measures are not ony feasible but can guide the ventilatory management and improves the outcome of patients under mechanical ventilation. We have designed two studies, one for COVID-19 patients and one for the other forms of ARDS that are usally seen out of a pandemic. The study about COVID-19 patients is almost completed and we have been able to start the non-COVID study but we need additional funding to complete this 2nd study.