BEST (Burn Center Evaluation of Standard Therapies) Ventilator Mode Study-

Not Applicable

Terminated

Interventions: Device: Ventilation - ARDSnet
Device: Ventilation - High Frequency Percussive Ventilation

Brief Summary: The purpose of this study is to compare High Frequency Pressure Ventilation (HFPV) to conventional mechanical ventilation.

Hypothesis: Patients placed on HFPV will have significantly higher number of ventilator-free days compared to patients placed on a conventional volume mode.

Detailed Description: This is a prospective, randomized, controlled trial comparing HFPV to conventional ventilator modes in the support of burn patients with respiratory failure. Burn patients who develop the need for mechanical ventilation present a variety of challenges that call for innovative therapeutic options. Even in the absence of smoke inhalation injury,decreased chest wall compliance from full thickness burns as well as massive fluid requirements are just a few variables that make it difficult to achieve gas exchange goals when attempting to apply conventional lung protective strategies recommended by the ARDS Net investigators.

Recruitment & Eligibility

Inclusion Criteria

Patients who are deemed to require ventilatory support for more than 24 hours from the time of screening.

Exclusion Criteria

Anticipated extubation within 24 hours of screening
Patients who are pregnant Patients not expected to survive for more than 24 hours

Arm && Interventions

Group	Intervention	Description
Conventional	Ventilation - ARDSnet	Standard ventilator support for non burned patients utilizing lung protective low tidal volume ventilation
High Frequency	Ventilation - High Frequency Percussive Ventilation	Provide standard ventilatory support for burn patients utilizing high frequency percussive ventilation

Primary Outcome Measures

Name	Time	Method
Ventilator-free Days During the First 28 Days	28 days	The primary end point was ventilator-free days in the first 28 days, defined as the number of days after randomization from day 0 to day 28 alive without ventilator assistance for at least 48 consecutive hrs.

Secondary Outcome Measures

Name	Time	Method
Ventilator Associated Pneumonia	28 days	Those who develop both clinical and microscopic evidence of pulmonary infection while on the ventilator.
Need for Rescue Ventilator	28 days	Subjects who did not meet predetermined oxygenation and ventilation goals on the study mode despite ventilator- specific optimization were switched to a rescue mode of ventilation.
Days Free From Nonpulmonary Organ Failure	28	days free from nonpulmonary organ failure as adapted from the ARDSnet study in the first 28 days.
Death	during hospitalization	In-hospital death.
Barotrauma	28 days	Defined as a new pneumothorax, pneumomediastinum, subcutaneous emphysema, interstitial emphysema, or pneumatocele \>2 cm in diameter not associated with a vascular procedure, lung biopsy, or thoracentesis.
Ventilator Associated Tracheobronchitis (VATB)	checked daily	Defined as carinal or mainstem airway friability and sloughing with associated bleeding. Only diagnosed after the patient had spent at least 7 days on the assigned ventilator mode and had not been diagnosed with inhalation injury on admission