Personalized Mechanical Ventilation to Reduce Right Ventricular Loading in Intensive Care Unit Patients with the Acute Respiratory Distress Syndrome

The COVID-19 pandemic raised awareness about a sudden, severe lung injury that can be caused by infections. Severe lung injury is often treated with a breathing machine (mechanical ventilator) and the mortality rate from this condition is 35-46%. A major cause of death in patients with lung injury is failure of the right side of the heart. Right heart failure develops in over 20% of patients and occurs, in part because of increased load on the heart caused by the ventilator inflating the injured lung. Our work has shown that the way physicians set the ventilator can affect the load on the right heart, likely due to effects on where air and blood flow occur in the lungs. Currently, there is a lack of data to guide clinicians in selecting ventilator settings that protect the heart in patients with lung injury. We will study this problem with an emerging technology called electrical impedance tomography (EIT). EIT is a non-invasive, bedside tool that only requires putting electrodes around the chest. EIT can measure the distribution of air in the lung and recent innovations allow for simultaneous measurements of blood flow in the lung so that the matching of air and blood flow can be assessed. This matching of air and blood flow is critical because it determines the amount of oxygen in the blood, but it also affects the load on the right heart. We expect that a personalized approach to treating patients with lung injury that uses EIT to guide the setting of mechanical ventilation will be more protective of the right heart compared to conventional management. We will evaluate this by measuring pressures in and around the lungs and heart as well as overall blood flow and oxygen in the blood. These data will assist clinicians in using available, non-invasive tools to tailor mechanical ventilation to the individual physiologic characteristics of their patients to optimize lung and heart health and could lead to improved long-term outcomes.