Please select the eligibility criteria that correspond to the clinical trial below.
Title: A RCT of Mechanical Ventilation, Directed by Esophageal Pressure Measurements, in Patients With Acute Lung Injury
Brief Summary: The purpose of this study is to see whether esophageal pressure (PES) measurements will allow the investigators to choose the best method of mechanical ventilation in patients with acute lung injury (ALI).


Options:
A: Inclusion Criteria:

* Intubated and mechanically ventilated
* Diagnosis of ARDS using American-European consensus criteria
* Enrollment in study \< 48 hours since diagnosis of ARDS
* For 12-36 hrs. (ideally 12-24 hrs) after diagnosis of ARDS, patient must be ventilated as follows: Volume A/C, Tidal volume of 4-8 ml/kg PBW, Plateau pressure ≤ 30 cmH2O, PEEP/FIO2 adjustments using ARDSnet table, Ventilator rate to keep PaCO2 = 35-60 mmHg
* During the 12-36 hour(ideally 12-24 hr) period, PaO2/FIO2 must remain \< 200 mm Hg for an ABG obtained 30 minutes after placement on the following specific ventilator settings: Volume A/C, Tidal volume = 6 ml/kg PBW, Plateau pressure ≤ 30 cmH2O, Inspiratory time ≤ 1 second, PEEP ≥ 10 cmH2O, FIO2 ≥ 0.5, Ventilator rate to keep PaCO2 = 35-60 mmHg
* No lung recruitment maneuvers or adjunct therapy.
* Total time on mechanical ventilation \< 96 hrs. at time of randomization.

Exclusion Criteria:

* Age \< 18 years or \> 80 years
* Weight \< 35 kg PBW
* Body mass index \> 60
* Intubated 2° to acute exacerbation of a chronic pulmonary disease
* Acute brain injury (ICP \> 18 mmHg)
* Immunosuppression 2° to chemo- or radiation therapy
* Severe cardiac disease(one of the following): New York Heart Association Class 3 or 4, acute coronary syndrome or persistent ventricular tachyarrhythmias
* Positive laboratory pregnancy test
* Sickle cell disease
* Neuromuscular disease
* High risk of mortality within 3 months from cause other than ARDS, e.g. cancer
* More than 2 organ failures (not including pulmonary system)
* Documented lung barotrauma, i.e. chest tube placement other than for fluid drainage
* Persistent hemodynamic instability or intractable shock
* Penetrating chest trauma
* Enrollment in another interventional study
B: Inclusion Criteria:

Patients with ALI/ARDS according to the International Consensus Conference criteria:

* PaO2/FiO2 ratio \< 300
* Acute onset
* Bilateral infiltrates on chest radiography
* PAOP \< 18 or, in patients without a pulmonary artery catheter, no other evidence of abnormal cardiac function

Exclusion Criteria:

* Patients with esophageal varices
* Patients with esophageal trauma
* Patients with recent esophageal surgery
* Patients with coagulopathy (platelets \< 80k or International Normalized Ratio \[INR\]\> 2 )
* Post transplant patients
* Patients with significant broncho-pleural fistula
C: Inclusion Criteria:

* Mechanical ventilation through an endotracheal tube
* Bilateral infiltrates consistent with pulmonary edema
* PaO2/FiO2 \< 300 mmHg
* No clinical evidence of left atrial hypertension. If measured, pulmonary artery occlusion pressure \< 18 mmHg
* Criteria 1, 2 et 3 jointly present for less than 48 hours
* Written informed consent obtained from the patient or surrogate

Exclusion Criteria:

* Age \< 18 years
* Pregnancy
* Expected duration of mechanical ventilation through an endotracheal tube \< 48 hours
* Participation in other trials within the previous 30 days
* Increased intracranial pressure
* Severe chronic respiratory disease
* Morbid obesity (weight \> 1kg/cm)
* Sickle cell disease
* Bone marrow transplant or chemotherapy-induced neutropenia
* Extended burns (\> 30 % total body surface area)
* Severe chronic liver disease (Child-Pugh score C)
* Pneumothorax
D: Inclusion Criteria:

* Man or female older than 18 years
* ARDS since less than 12 hours
* PaO2 / FiO2 \< 200 avec une PEEP ≥ 5 (Berlin Moderate or severe)

Exclusion Criteria:

* brain injury with high ICP
* BMT Liver Cirrhosis Child C Pregnancy Burns Morbid obese patients (BMI \> 40) Moribund

Answer: B