{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T09:25:01Z","timestamp":1762680301972,"version":"build-2065373602"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:00:00Z","timestamp":1750636800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Patients with severe burn injuries are at risk of developing acute respiratory distress syndrome (ARDS). Modern ARDS management does not typically factor in how burn injury influences lung dynamics during ventilator management. Obtaining indirect intrapleural pressures via esophageal pressure monitoring (Pes) may provide unique guidance on optimal positive end expiratory pressure (PEEP) titration to prevent alveolar collapse while ensuring safe plateau pressures but is not well described in burn injured patients. This work examined the use of Pes in burn injured patients with ARDS to determine its effect on ventilator changes. Burn injured patients admitted to an ABA verified burn center that developed ARDS by the Berlin definition and received Pes were retrospectively reviewed to determine ventilator settings and oxygenation trends. Severity of ARDS and oxygenation were determined by PaO2 to FiO2 (P\/F) ratios and oxygenation indices (OI) prior to Pes use, and at 1-, 3- and 5-day intervals following initiation. Of the 23 patients included, the median revised Baux score was 91.6 (73.9-114.6), and the mortality rate was 82.6%. Increases in PEEP were required [12 (4) vs 17 (4); P\u00a0&amp;lt;\u2009.0001] following Pes initiation. P\/F ratios increased by day 5 post-Pes monitoring [300 (35.1)] compared to pre- [141 (26.5); P\u00a0=\u2009.0020], 1\u00a0day post- [169 (26.5); P\u00a0=\u2009.0134] and 3\u00a0days post- [179 (29.4); P\u00a0=\u2009.0325] monitoring. OI between pre-Pes monitoring and day 5 post Pes monitoring, were not significant [17.3 (1.92) vs 13.4 (2.57)]. A strategy incorporating Pes to guide ventilator management in burn injured patients with ARDS may be used.<\/jats:p>","DOI":"10.1093\/jbcr\/iraf119","type":"journal-article","created":{"date-parts":[[2025,7,5]],"date-time":"2025-07-05T07:48:11Z","timestamp":1751701691000},"page":"1255-1261","source":"Crossref","is-referenced-by-count":0,"title":["Utilizing Indirect Intrapleural Pressure to Guide Mechanical Ventilation in Burn Patients With ARDS"],"prefix":"10.1093","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8332-5293","authenticated-orcid":false,"given":"Amanda M","family":"Soo Ping Chow","sequence":"first","affiliation":[{"name":"Firefighters\u2019 Burn and Surgical Research Laboratory, MedStar Health Research Institute , Washington, DC 20010 ,","place":["United States"]},{"name":"Department of Surgery, The Burn Center, MedStar Washington Hospital Center , Washington, DC 20010 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura S","family":"Johnson","sequence":"additional","affiliation":[{"name":"Walter L. Ingram Burns Center, Grady Memorial Hospital , Atlanta, GA 30303 ,","place":["United States"]},{"name":"Emory School of Medicine , Atlanta, GA 30307 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1539-6346","authenticated-orcid":false,"given":"Tuan D","family":"Le","sequence":"additional","affiliation":[{"name":"Firefighters\u2019 Burn and Surgical Research Laboratory, MedStar Health Research Institute , Washington, DC 20010 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa","family":"McLawhorn","sequence":"additional","affiliation":[{"name":"Firefighters\u2019 Burn and Surgical Research Laboratory, MedStar Health Research Institute , Washington, DC 20010 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren T","family":"Moffatt","sequence":"additional","affiliation":[{"name":"Firefighters\u2019 Burn and Surgical Research Laboratory, MedStar Health Research Institute , Washington, DC 20010 ,","place":["United States"]},{"name":"Department of Surgery, Georgetown University School of Medicine , Washington, DC 20007 ,","place":["United States"]},{"name":"Department of Biochemistry and Molecular and Cellular Biology, Georgetown University School of Medicine , Washington, DC 20007 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0519-4388","authenticated-orcid":false,"given":"Taryn E","family":"Travis","sequence":"additional","affiliation":[{"name":"Firefighters\u2019 Burn and Surgical Research Laboratory, MedStar Health Research Institute , Washington, DC 20010 ,","place":["United States"]},{"name":"Department of Surgery, The Burn Center, MedStar Washington Hospital Center , Washington, DC 20010 ,","place":["United States"]},{"name":"Department of Surgery, Georgetown University School of Medicine , Washington, DC 20007 ,","place":["United States"]},{"name":"Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine , Washington, DC 20007 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4394-6416","authenticated-orcid":false,"given":"Jeffrey W","family":"Shupp","sequence":"additional","affiliation":[{"name":"Firefighters\u2019 Burn and Surgical Research Laboratory, MedStar Health Research Institute , Washington, DC 20010 ,","place":["United States"]},{"name":"Department of Surgery, The Burn Center, MedStar Washington Hospital Center , Washington, DC 20010 ,","place":["United States"]},{"name":"Department of Surgery, Georgetown University School of Medicine , Washington, DC 20007 ,","place":["United States"]},{"name":"Department of Biochemistry and Molecular and Cellular Biology, Georgetown University School of Medicine , Washington, DC 20007 ,","place":["United States"]},{"name":"Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine , Washington, DC 20007 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5478-8935","authenticated-orcid":false,"given":"Shawn","family":"Tejiram","sequence":"additional","affiliation":[{"name":"Firefighters\u2019 Burn and Surgical Research Laboratory, MedStar Health Research Institute , Washington, DC 20010 ,","place":["United States"]},{"name":"Department of Surgery, The Burn Center, MedStar Washington Hospital Center , Washington, DC 20010 ,","place":["United States"]},{"name":"Department of Surgery, Georgetown University School of Medicine , Washington, DC 20007 ,","place":["United States"]},{"name":"Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine , Washington, DC 20007 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,6,23]]},"reference":[{"key":"2025110904200615900_ref1","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1016\/j.suc.2023.01.006","article-title":"Acute respiratory distress syndrome, mechanical ventilation, and inhalation injury in burn patients","volume":"103","author":"Bittner","year":"2023","journal-title":"Surg Clin North Am"},{"key":"2025110904200615900_ref2","first-page":"162","article-title":"Are esophageal pressure measurements important in clinical decision-making in mechanically ventilated patients?","volume":"55","author":"Talmor","year":"2010","journal-title":"Respir Care"},{"key":"2025110904200615900_ref3","doi-asserted-by":"publisher","first-page":"2126","DOI":"10.1056\/NEJMra1208707","article-title":"Ventilator-induced lung injury","volume":"369","author":"Slutsky","year":"2013","journal-title":"N Engl J Med"},{"key":"2025110904200615900_ref4","doi-asserted-by":"publisher","first-page":"1301","DOI":"10.1056\/NEJM200005043421801","article-title":"Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome","volume":"342","author":"Acute Respiratory Distress Syndrome Network","year":"2000","journal-title":"N Engl J Med"},{"key":"2025110904200615900_ref5","doi-asserted-by":"publisher","first-page":"882","DOI":"10.1016\/S2213-2600(16)30305-8","article-title":"Epidemiological characteristics, practice of ventilation, and clinical outcome in patients at risk of acute respiratory distress syndrome in intensive care units from 16 countries (PRoVENT): an international, multicentre, prospective study","volume":"4","author":"Neto","year":"2016","journal-title":"Lancet Respir Med"},{"key":"2025110904200615900_ref6","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1056\/NEJM199802053380602","article-title":"Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome","volume":"338","author":"Amato","year":"1998","journal-title":"N Engl J Med"},{"key":"2025110904200615900_ref7","doi-asserted-by":"publisher","first-page":"762","DOI":"10.1016\/j.burns.2019.05.015","article-title":"Changes in ventilator settings and ventilation-induced lung injury in burn patients\u2014a systematic review","volume":"46","author":"Glas","year":"2020","journal-title":"Burns."},{"key":"2025110904200615900_ref8","doi-asserted-by":"publisher","first-page":"2095","DOI":"10.1056\/NEJMoa0708638","article-title":"Mechanical ventilation guided by esophageal pressure in acute lung injury","volume":"359","author":"Talmor","year":"2008","journal-title":"N Engl J Med"},{"key":"2025110904200615900_ref9","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1152\/japplphysiol.00697.2005","article-title":"Volume-related and volume-independent effects of posture on esophageal and transpulmonary pressures in healthy subjects","volume":"100","author":"Washko","year":"2006","journal-title":"J Appl Physiol (1985)"},{"key":"2025110904200615900_ref10","doi-asserted-by":"publisher","first-page":"220186","DOI":"10.1183\/16000617.0186-2022","article-title":"The oesophageal balloon for respiratory monitoring in ventilated patients: updated clinical review and practical aspects","volume":"32","author":"Jonkman","year":"2023","journal-title":"Eur Respir Rev"},{"key":"2025110904200615900_ref11","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1164\/rccm.201312-2193CI","article-title":"The application of esophageal pressure measurement in patients with respiratory failure","volume":"189","author":"Akoumianaki","year":"2014","journal-title":"Am J 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syndrome","volume":"13","author":"Dostal","year":"2023","journal-title":"J Pers Med"},{"key":"2025110904200615900_ref15","doi-asserted-by":"publisher","first-page":"2526","DOI":"10.1001\/jama.2012.5669","article-title":"Acute respiratory distress syndrome: the berlin definition","volume":"307","author":"ARDS Definition Task Force","year":"2012","journal-title":"JAMA."},{"key":"2025110904200615900_ref16","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-025-07786-4","article-title":"Oxygenation indexes for classification of severity of ARDS","volume":"51","author":"El-Khatib","journal-title":"Intensive Care Med"},{"key":"2025110904200615900_ref17","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1164\/rccm.200405-625OC","article-title":"Oxygenation index predicts outcome in children with acute hypoxemic respiratory failure","volume":"172","author":"Trachsel","year":"2005","journal-title":"Am J Respir Crit Care 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meta-analysis","volume":"303","author":"Briel","year":"2010","journal-title":"JAMA."},{"key":"2025110904200615900_ref21","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1056\/NEJMoa032193","article-title":"Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome","volume":"351","author":"Brower","year":"2004","journal-title":"N Engl J Med"},{"key":"2025110904200615900_ref22","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1093\/jbcr\/irab169","article-title":"Outcomes in ventilated burn patients with acute respiratory distress syndrome: an evaluation of early high-PEEP strategy using berlin criteria","volume":"43","author":"Perry","year":"2022","journal-title":"J Burn Care Res"},{"key":"2025110904200615900_ref23","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1152\/japplphysiol.00835.2009","article-title":"Esophageal pressures in acute lung injury: do they represent artifact or useful information about transpulmonary pressure, chest wall mechanics, and lung stress?","volume":"108","author":"Loring","year":"2010","journal-title":"J Appl Physiol (1985)"},{"key":"2025110904200615900_ref24","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1007\/s00134-012-2490-7","article-title":"ECMO criteria for influenza A (H1N1)-associated ARDS: role of transpulmonary pressure","volume":"38","author":"Grasso","year":"2012","journal-title":"Intensive Care Med"},{"key":"2025110904200615900_ref25","doi-asserted-by":"publisher","first-page":"1206","DOI":"10.1007\/s00134-016-4403-7","article-title":"Mortality and pulmonary mechanics in relation to respiratory system and transpulmonary driving pressures in ARDS","volume":"42","author":"Baedorf Kassis","year":"2016","journal-title":"Intensive Care Med"},{"key":"2025110904200615900_ref26","doi-asserted-by":"publisher","first-page":"846","DOI":"10.1001\/jama.2019.0555","article-title":"Effect of titrating positive end-expiratory pressure (PEEP) with an esophageal pressure-guided strategy vs an empirical high PEEP-FiO2 strategy on death and days free from mechanical ventilation among patients with acute respiratory distress syndrome: a randomized clinical trial","volume":"321","author":"Beitler","year":"2019","journal-title":"JAMA."}],"container-title":["Journal of Burn Care &amp; Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jbcr\/advance-article-pdf\/doi\/10.1093\/jbcr\/iraf119\/63701868\/iraf119.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jbcr\/article-pdf\/46\/6\/1255\/63701868\/iraf119.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jbcr\/article-pdf\/46\/6\/1255\/63701868\/iraf119.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T09:20:14Z","timestamp":1762680014000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jbcr\/article\/46\/6\/1255\/8193368"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,23]]},"references-count":26,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,23]]},"published-print":{"date-parts":[[2025,11,5]]}},"URL":"https:\/\/doi.org\/10.1093\/jbcr\/iraf119","relation":{},"ISSN":["1559-047X","1559-0488"],"issn-type":[{"type":"print","value":"1559-047X"},{"type":"electronic","value":"1559-0488"}],"subject":[],"published-other":{"date-parts":[[2025,11]]},"published":{"date-parts":[[2025,6,23]]}}}