May 4, 2000
Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome.
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).
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.