Airway Pressure Release Ventilation as a Preventative Strategy

• Trauma patients age 16 or older
• Trauma patients requiring ventilatory support within 48 hours of injury
• Those with anticipated ventilatory support ≥ 24 hours
• Subject or authorized representative (AR) has signed an informed consent form (ICF)
• Subjects age 16 or 17 who have signed an assent document and/or AR has signed an ICF

Exclusion Criteria:

• Significant chronic lung disease defined as lung pathology requiring home O2 use
• Chronic heart disease defined as NYHC III or higher
• Persistent bronchopulmonary air leak
• Contraindications to permissive hypercapnia (ex. Intracerebral bleeding, brain tumor, fulminant hepatic failure, and hemodynamic instability)
• Pulmonary artery occlusion pressures ≥ 18 mmHg
• Severe neurologic injury that may prevent the patient from having a reasonable opportunity for weaning as determined by the clinical study team
• Immuno-compromised patients secondary to drugs or disease
• Neuromuscular disease that impairs ability to ventilate spontaneously (ex. Spinal injury at or above C5, ALS, Guillain-Barre syndrome, Myasthenia Gravis)
• History of pneumonectomy
• Pregnancy
• Burns with TBSA ≥ 20%
• Acute MI as the cause of ALI/ARDS
• All other contraindications to APRV
• Patients who cannot be randomized within 12 hours of intubation