ARMA Trial

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.

Summarized by: 

Mazen Kherallah

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.

ARMA Trial