Mechanical Ventilation Controlled by the Electrical Activity of the Patient's Diaphragm - Effects on Cardiac Performance

Inclusion criteria

• Male or female patients aged 18 - 85 years (extremes included)
• Mechanical ventilation (tracheally intubated or tracheotomized)
• Relevant interaction between the ventilator and the cardiac performance defined as an inspiratory deflection in central venous pressure or pulmonary diastolic pressure of ≥ 5 mmHg

• in 10 patients with impaired cardiac performance defined as either

• a left ventricular ejection fraction of < 40% and/or
• treatment with dobutamine ≥2μg/kg/min, or adrenaline ≥ 3μg/kg/min and/or
• a cardiac index of ≤ 2.2 L•min-1•m2 and/or
• a pulmonary artery occlusion pressure (PAOP) ≥ 18 mmHg
• in 10 patients with a history of chronic obstructive pulmonary disease (COPD) and delayed triggering-ON / cycling-OFF and/or evidence for wasted inspiratory efforts as evidenced by:

• limitation of expiratory air flow and intrinsic PEEP as assessed by observation of the expiratory air flow curve and measurement of the airway pressure during an expiratory hold maneuver and/or
• excessive activation of inspiratory and / or expiratory muscles as assessed by observation of the patient
• Presence of a pulmonary artery catheter and an arterial pressure line
• Subject itself or its next of kin has given written informed consent

Exclusion criteria

• Patient is less than 18 years or more than 80 years of age
• The attending physician refuses to allow enrollment
• The patient refuses informed consent
• Next of kin is unavailable or refuses informed consent
• Pregnant or breast-feeding female. A pregnancy test will be performed in all female patients less than 60 years of age. The patient will not be enrolled in the study if the test result is positive.
• Any contraindication to insertion/exchange a nasogastric tube, including (but not limited to): severe oropharyngeal malformation or bleeding; esophageal varices, tumor, infection, stenosis, or rupture
• Presence or suspicion of diaphragm injury
• Hemophilia or other severe bleeding disorder
• Presence or suspicion of a central nervous system (CNS) disorder, including (but not limited to): CNS infarction, bleeding, tumor, or infection
• History of heart and/or lung transplantation
• Any mechanical cardiac assist device (including intraaortic balloon pump)
• Any contraindication to reduce sedation or to stop neuromuscular blockage in order to allow spontaneous breathing
• The patient needs to be ventilated with a mode of MV controlling for tidal volume or for airway pressure as per attending physician.
• Severe hemodynamic instability as judged by the attending physician
• Planned or anticipated intervention within the study period necessitating either transfer out of the ICU or requiring prolonged interaction with the patient.
• a fraction of inspired oxygen (FiO2) of > 0.8
• The patient currently participates in another interventional clinical trial