NEJM
May 4, 2000
Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome.
Mazen Kherallah
Summarized by:
What was the research question?
Does the ventilation of low tidal volume improve the mortality rate or the ventilator-free days in patients with acute lung injury and ARDS compared to traditional higher tidal volume ventilation?
How did they do it?
Multicenter, randomized trial in 10 university-associated hospitals across the USA.
861 patients with acute lung injury and ARDS (PaO2:FiO2 of <300.
Patients were randomized to receive low tidal volume ventilation with 6 ml/kg/breath (ideal body weight) and plateau pressure < 30 cm water, or traditional higher tidal volume ventilation with 12 ml/kg/breath (ideal body weight) and plateau pressure <50 cm H2O.
Primary outcome was in-hospital mortality and number of ventilator-free days on day #28.
What did they find?
Lower tidal volume ventilation was associated with a reduced in-hospital mortality (39.8% vs 31.0%, p=0.007).
Number of ventilator-free days was higher in the low tidal volume group (12±11 days vs 10±11 days, p=0.007).
Any limitations?
Single blinded study.
What does it mean?
In patients with acute lung injury or ARDS, a ventilation strategy with lower tidal volume ventilation of 6 mL/kg of ideal body weight and limited plateau pressure of ≤ 30 cmH2O improves mortality and ventilator free days.
Highly impacted practice and became the standard of care.