A Diaphragmatic Electrical Activity Based Optimization Strategy During Pressure Support Ventilation

Inclusion Criteria:

Patients who are ventilated using a partial ventilator support mode (i.e. pressure support) and meet one of the following criteria:

• Known chronic pulmonary obstructive disease
• Suspected Intrinsic PEEP on the expiratory airway pressure and flow tracings
• Resistive pressure (i.e. eak pressure-Plateau pressure) higher than 20 centimeters of water (cmH2O) at a flow of 60 L/min or higher than 15 at a flow of 45 L/min in volume controlled ventilation (preferably after a tracheal aspiration maneuver)
• Known chronic restrictive pulmonary disease with respiratory failure
• Restrictive pulmonary disease characterized by a measured compliance of less than 30 ml/cmH2O
• Obesity with BMI ≥ 30 kg/m2
• Existence of frequent asynchronies noticed on the ventilator waveforms
• Expected duration of ventilation of more than 24 hours

Exclusion Criteria:

• Contraindication to Naso/orogastric tube (NGT/OGT) placement (known esophageal problem such as hiatal hernia or esophageal varicosities, active upper gastro-intestinal bleeding, any other contraindication to the insertion of a NGT/OGT)
• Poor short term prognosis (defined by the clinician in charge as a high risk of death during the next 7 days) or ongoing palliative treatment.
• Patients with "Do not resuscitate" order already established and in palliative care
• Patients younger than 18 years old