TY - JOUR
T1 - Prospective, randomized, controlled clinical trial comparing traditional versus reduced tidal volume ventilation in acute respiratory distress syndrome patients
AU - Brower, Roy G.
AU - Shanholtz, Carl B.
AU - Fessler, Henry E.
AU - Shade, David M.
AU - White, Peter
AU - Wiener, Charles M.
AU - Teeter, John G.
AU - Dodd-o, Jeffrey M.
AU - Almog, Yaniv
AU - Piantadosi, Steven
PY - 1999/9/6
Y1 - 1999/9/6
N2 - Objective: To assess the safety and potential efficacy of a mechanical ventilation strategy designed to reduce stretch-induced lung injury in acute respiratory distress syndrome. Design: Prospective, randomized, controlled clinical trial. Setting: Eight intensive care units in four teaching hospitals. Patients: Fifty-two patients with acute respiratory distress syndrome. Interventions: Traditional tidal volume patients; tidal volume 10- 12 mL/kg ideal body weight, reduced if inspiratory plateau pressure was >55 cm H2O (7.3 kPa). Small tidal volume patients: tidal volume 5-8 mL/kg ideal body weight, to keep plateau pressure < 30 cm H2O (4.0 kPa). Measurements and Main Results: Mean tidal volumes during the first 5 days in traditional and small tidal volume patients were 10.2 and 7.3 mL/kg, respectively (p < .001), with mean plateau pressure = 30.6 and 24.9 cm H20 (3.3 kPa), respectively (p < .001). There were no significant differences in requirements for positive end-expiratory pressure of FIO2, fluid intakes/outputs, requirements for vasopressors, sedatives, or neuromuscular blocking agents, percentage of patients that achieved unassisted breathing, ventilator days, or mortality. Conclusions: The reduced tidal volume strategy used in this study was safe. Failure to observe beneficial effects of small tidal volume ventilation treatment in important clinical outcome variables may have occurred because a) the sample size was too small to discern small treatment effects; b) the differences in tidal volumes and plateau pressures were modest; or c) reduced tidal volume ventilation is not beneficial.
AB - Objective: To assess the safety and potential efficacy of a mechanical ventilation strategy designed to reduce stretch-induced lung injury in acute respiratory distress syndrome. Design: Prospective, randomized, controlled clinical trial. Setting: Eight intensive care units in four teaching hospitals. Patients: Fifty-two patients with acute respiratory distress syndrome. Interventions: Traditional tidal volume patients; tidal volume 10- 12 mL/kg ideal body weight, reduced if inspiratory plateau pressure was >55 cm H2O (7.3 kPa). Small tidal volume patients: tidal volume 5-8 mL/kg ideal body weight, to keep plateau pressure < 30 cm H2O (4.0 kPa). Measurements and Main Results: Mean tidal volumes during the first 5 days in traditional and small tidal volume patients were 10.2 and 7.3 mL/kg, respectively (p < .001), with mean plateau pressure = 30.6 and 24.9 cm H20 (3.3 kPa), respectively (p < .001). There were no significant differences in requirements for positive end-expiratory pressure of FIO2, fluid intakes/outputs, requirements for vasopressors, sedatives, or neuromuscular blocking agents, percentage of patients that achieved unassisted breathing, ventilator days, or mortality. Conclusions: The reduced tidal volume strategy used in this study was safe. Failure to observe beneficial effects of small tidal volume ventilation treatment in important clinical outcome variables may have occurred because a) the sample size was too small to discern small treatment effects; b) the differences in tidal volumes and plateau pressures were modest; or c) reduced tidal volume ventilation is not beneficial.
KW - Acute lung injury
KW - Acute respiratory distress syndrome (ARDS)
KW - Mechanical ventilation
KW - Permissive hypercapnia
KW - Plateau pressure
KW - Tidal volume
UR - http://www.scopus.com/inward/record.url?scp=0004539015&partnerID=8YFLogxK
U2 - 10.1097/00003246-199908000-00015
DO - 10.1097/00003246-199908000-00015
M3 - Article
C2 - 10470755
AN - SCOPUS:0004539015
SN - 0090-3493
VL - 27
SP - 1492
EP - 1498
JO - Critical Care Medicine
JF - Critical Care Medicine
IS - 8
ER -