# Breath stacking dyssynchrony in acute respiratory distress syndrome

> **NIH NIH K23** · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2021 · $170,856

## Abstract

PROJECT SUMMARY/ABSTRACT
This proposal details a five-year research and career development plan for Jeremy R. Beitler, MD, MPH, a
pulmonary intensivist and Assistant Professor at the University of California, San Diego. The overall focus of
his research is to quantify at bedside key biomechanical determinants of lung injury in patients with ARDS to
inform development of novel lung-protective strategies tailored to patient-specific risk. This K23 award will
provide the necessary support for Dr. Beitler to attain the following goals: (1) to acquire a foundation in
biomechanics and bioinstrumentation; (2) to gain proficiency in physiological signal processing; (3) to expand
his expertise in ARDS lung biology; and (4) to gain proficiency in longitudinal data analysis. Dr. Beitler has
assembled a highly collaborative team of senior investigators to support his research training and career
development. His primary mentor, Dr. Atul Malhotra, is expert in respiratory physiology, signal processing, and
ventilatory control, and co-mentor Dr. Michael Matthay is a preeminent clinical-translational investigator in
biology of acute lung injury. His training team also includes expert consultants in biomechanics (Dr. Andrew
McCulloch) and longitudinal data analysis (Dr. Sonia Jain). Mechanical ventilation with low tidal volumes
decreases lung injury and improves survival in patients with ARDS. Breath stacking dyssynchrony (BSD)
describes a patient-ventilator interaction in which consecutive machine inspiratory cycles occur with incomplete
exhalation between them, causing higher tidal volumes than intended. At least two mechanistically distinct
BSD subtypes exist, differentiated by the timing and pattern of neural inspiration. Distinguishing between BSD
subtypes may be important for developing effective interventions that (1) minimize risk of ventilator-induced
lung injury and (2) avoid side-effects of deep sedation often prescribed in attempt to abate BSD. Dr. Beitler’s
central hypothesis is that BSD subtypes are associated with dissimilar clinical factors but have similar
implications for lung injury in ARDS. Dr. Beitler will evaluate the relationship of BSD subtypes with hypercapnia
(Aim 1) and deep sedation (Aim 2), two clinically discernable factors that could serve as therapeutic targets for
future study. Dr. Beitler also will identify the exposure-response relationship of BSD with lung injury, as
measured by plasma biomarkers of alveolar injury (Aim 3). To achieve these aims, Dr. Beitler will build a
prospective cohort of patients with ARDS in whom airflow, airway pressure, and esophageal pressure are
measured continuously to quantify BSD by subtype. Repeated measures of plasma biomarkers will be used to
gauge lung injury. This research and career development plan provides Dr. Beitler a strong foundation to
become an independent investigator studying BSD subtype-specific therapies to curb unnecessary sedative
use and improve adherence to lung-protective ve...

## Key facts

- **NIH application ID:** 10150069
- **Project number:** 5K23HL133489-06
- **Recipient organization:** COLUMBIA UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Jeremy R. Beitler
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $170,856
- **Award type:** 5
- **Project period:** 2017-08-01 → 2022-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10150069

## Citation

> US National Institutes of Health, RePORTER application 10150069, Breath stacking dyssynchrony in acute respiratory distress syndrome (5K23HL133489-06). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10150069. Licensed CC0.

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