FYI from the NHLBI Index

May 2009: Vol. 10, Issue 1
In the News

News from Capitol Hill

Science Advance from the NHLBI

• New Mechanical Ventilation Strategy Improves Outcomes for ARDS Patients

American Recovery and Reinvestment Act

Appropriations for Fiscal Year (FY) 2009

Executive Order on Stem Cells

On March 9, 2009, the President signed an Executive Order (EO) removing restrictions on federal funding of human embryonic stem cell research. The order revokes the presidential statement of August 9, 2001, limiting federal funding for research involving human embryonic stem cells, and EO13435 of June 20, 2007, which supplements the August 9, 2001, statement. The EO requires the HHS Secretary, through the NIH Director, to review existing NIH and other widely-recognized guidelines on human stem cell research and issue new NIH guidance within 120 days.

New HHS Secretary Confirmed

On April 28, 2009, the Senate confirmed Kansas Governor Kathleen Sebelius as Secretary of the Department of Health and Human Services (HHS). She was nominated by the President on March 2, 2009.

Recent Advance from the NHLBI

New Mechanical Ventilation Strategy Improves Outcomes for ARDS Patients

Acute respiratory distress syndrome (ARDS) is a serious lung injury that is characterized by pulmonary edema and high mortality. The only effective therapy is mechanical ventilation. In recent years, a significant clinical breakthrough was achieved when investigators determined that mechanical ventilation using a small breath size, or tidal volume, is clearly superior to using large volumes. Although this approach significantly improved the survival of ARDS patients, the mortality rate still exceeds 30 percent — and subsequent efforts to improve the survival rate have been unsuccessful.

Results from a new trial indicate that clinical outcomes for ARDS patients can be significantly improved over results achieved through standard ventilator therapy by adjusting the level of mechanical ventilation pressure to account for characteristics of an individual patient’s lung and chest wall, which are determined by pressure readings measured in the esophagus. Investigators used a balloon catheter to measure the esophageal pressure for each patient, then either slightly increased or decreased the amount of ventilation pressure applied to the lungs at the end of each breath depending on whether the esophageal pressure was high or low, respectively. The study designers initially believed that 100 patients per treatment group would be necessary to detect a statistically relevant difference between standard ventilator therapy and the esophageal-pressure–guided approach; however, lung oxygenation, a predictor of ARDS survival, was improved so significantly by the new approach that treatment of only 60 patients with the new method was sufficient to validate its efficacy, and the study was halted early.

If confirmed in larger clinical trials, this new strategy of determining a patient’s esophageal pressure and then adjusting the mechanical ventilator pressure accordingly may lead to a substantial improvement in ARDS survival.

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