Neural Pressure Support, Synchrony and Respiratory Muscle Unloading (NPS)

In this study patients who are intubated and on ventilator for more than 24h will be ventilated at three different level of support in Pressure Support and Neural Pressure Support to study patient-ventilator synchrony and muscle unloading.

This study is an interventional randomized crossover study in intubated and mechanically ventilated patients for more than 24h. Eligible patients from whom informed consent is obtained and Pes and Edi catheter are successfully positioned are enrolled in the study. Patients will be ventilated in Pressure Support and Neural Pressure Support at three different level of assist (baseline, 50% and 150% of baseline respectively) in randomized order. Ventilator curves will be recorded and bloodgas obtained at the end of each study step, each lasting 20min.

Interventional prospective study. Each participant is ventilated both on PS and NPS at 3 different support levels.

Patients will be ventilated in Pressure Support and Neural Pressure Support at 3 different levels of support in randomized order

Nasogastric tube will be removed and replaced by a Esophageal catheter and Electrical Diaphragm activity catheter and mechanical ventilation in mode Neural Pressure Support

Inclusion Criteria: -Patients intubated for more than 24 hours in the weaning phase from the ventilator. Exclusion Criteria: bleeding disorders (PK INR>1,5 or APTT>50s or platelet count <50000/µL) unstable circulation (requiring high vasopressor dose, for example Noradrenalin >0,2µg/kg/min) severe lung disease (PFI ≤ 13,3 kPa) fever> 38,5°C pregnancy.