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Previous Volume 338:355-361 February 5, 1998 Number 6 Next

	Full Text PDF Editorial by Hudson, L. D. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background A strategy of mechanical ventilation that limits airway pressure and tidal volume while permitting hypercapnia has been recommended for patients with the acute respiratory distress syndrome. The goal is to reduce lung injury due to overdistention. However, the efficacy of this approach has not been established.

Methods Within 24 hours of intubation, patients at high risk for the acute respiratory distress syndrome were randomly assigned to either pressure- and volume-limited ventilation (limited-ventilation group), with the peak inspiratory pressure maintained at 30 cm of water or less and the tidal volume at 8 ml per kilogram of body weight or less, or to conventional ventilation (control group), with the peak inspiratory pressure allowed to rise as high as 50 cm of water and the tidal volume at 10 to 15 ml per kilogram. All other ventilatory variables were similar in the two groups.

Results A total of 120 patients with similar clinical features underwent randomization (60 in each group). The patients in the limited-ventilation and control groups were exposed to different mean (±SD) tidal volumes (7.2±0.8 vs. 10.8±1.0 ml per kilogram, respectively; P<0.001) and peak inspiratory pressures (23.6±5.8 vs. 34.0±11.0 cm of water, P<0.001). Mortality was 50 percent in the limited-ventilation group and 47 percent in the control group (relative risk, 1.07; 95 percent confidence interval, 0.72 to 1.57; P = 0.72). In the limited-ventilation group, permissive hypercapnia (arterial carbon dioxide tension, >50 mm Hg) was more common (52 percent vs. 28 percent, P = 0.009), more marked (54.4±18.8 vs. 45.7±9.8 mm Hg, P = 0.002), and more prolonged (146±265 vs. 25±22 hours, P = 0.017) than in the control group. The incidence of barotrauma, the highest multiple-organ-dysfunction score, and the number of episodes of organ failure were similar in the two groups; however, the numbers of patients who required paralytic agents (23 vs. 13, P = 0.05) and dialysis for renal failure (13 vs. 5, P = 0.04) were greater in the limited-ventilation group than in the control group.

Conclusions In patients at high risk for the acute respiratory distress syndrome, a strategy of mechanical ventilation that limits peak inspiratory pressure and tidal volume does not appear to reduce mortality and may increase morbidity.

Source Information

From the Departments of Medicine (T.E.S., J.T.G., S.E.L., A.S.S.), Surgery (T.R.J.T.), and Anaesthesia (T.E.S., C.D.M., R.F.M.) and the Critical Care Medicine Programme (T.E.S., M.O.M., J.T.G., S.E.L., C.D.M., R.F.M., A.S.S.), University of Toronto; Wellesley Central Hospital (T.E.S., B.D.S.); Toronto Hospital (J.T.G., T.R.J.T.); St. Michael's Hospital (C.D.M.); Sunnybrook Health Sciences Centre (R.F.M.); Mount Sinai Hospital (S.E.L., A.S.S.); and St. Joseph's Health Centre (T.S.R.) — all in Toronto; the Department of Medicine and the Critical Care Medicine Programme, McMaster University, Hamilton, Ont. (D.J.C.); and the Department of Medicine, University of Ottawa, Ottawa, Ont. (R.V.H.).

Address reprint requests to Dr. Stewart at Wellesley Central Hospital, Rm. 245, Jones Bldg., 160 Wellesley St. E., Toronto, ON M4Y 1J3, Canada.

Full Text of this Article

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Protective Ventilation for the Acute Respiratory Distress Syndrome
Chiche J.-D., Brunet F., Lamy M., Kacmarek R., Parsons P. E., Matthay M., Manning H. L., Shapira M. Y., Sviri S., Linton D. M., Weg J. G., Anzueto A., Amato M. B.P., Barbas C. S.V., Carvalho C. R.R., Stewart T. E., Meade M. O., Slutsky A. S.
Extract | Full Text  
N Engl J Med 1998; 339:196-199, Jul 16, 1998. Correspondence

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• Baudouin, S V (2001). Ventilator induced lung injury and infection in the critically ill. Thorax 56: ii50-57 [Full Text]  
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• Esteban, A., Alia, I., Gordo, F., de Pablo, R., Suarez, J., Gonzalez, G., Blanco, J. (2000). Prospective Randomized Trial Comparing Pressure-Controlled Ventilation and Volume-Controlled Ventilation in ARDS. Chest 117: 1690-1696 [Abstract] [Full Text]  
• The Acute Respiratory Distress Syndrome Network, (2000). Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome. NEJM 342: 1301-1308 [Abstract] [Full Text]  
• Ware, L. B., Matthay, M. A. (2000). The Acute Respiratory Distress Syndrome. NEJM 342: 1334-1349 [Full Text]  
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• NEUMANN, P., BERGLUND, J. E., ANDERSSON, L. G., MARIPU, E., MAGNUSSON, A., HEDENSTIERNA, G. (2000). Effects of Inverse Ratio Ventilation and Positive End-Expiratory Pressure in Oleic Acid-Induced Lung Injury. Am. J. Respir. Crit. Care Med. 161: 1537-1545 [Abstract] [Full Text]  
• Petrucci, N., Ranieri, V. M., Suter, P. M., Slutsky, A. S. (2000). Ventilator-Induced Lung Injury. JAMA 283: 1003-1004 [Full Text]  
• Truog, R. D., Burns, J. P., Mitchell, C., Johnson, J., Robinson, W. (2000). Pharmacologic Paralysis and Withdrawal of Mechanical Ventilation at the End of Life. NEJM 342: 508-511 [Full Text]  
• Stott, S. (2000). Recent advances: Recent advances in intensive care. BMJ 320: 358-361 [Full Text]  
• Hirvela, E. R. (2000). Advances in the Management of Acute Respiratory Distress Syndrome: Protective Ventilation. Arch Surg 135: 126-135 [Abstract] [Full Text]  
• MEADE, M. O., COOK, R. J., GUYATT, G. H., GROLL, R., KACHURA, J. R., BEDARD, M., COOK, D. J., SLUTSKY, A. S., STEWART, T. E. (2000). Interobserver Variation in Interpreting Chest Radiographs for the Diagnosis of Acute Respiratory Distress Syndrome. Am. J. Respir. Crit. Care Med. 161: 85-90 [Abstract] [Full Text]  
• (1999). International Consensus Conferences in Intensive Care Medicine: Ventilator-associated Lung Injury in ARDS . THIS OFFICIAL CONFERENCE REPORT WAS COSPONSORED BY THE AMERICAN THORACIC SOCIETY, THE EUROPEAN SOCIETY OF INTENSIVE CARE MEDICINE, AND THE SOCIETE DE REANIMATION DE LANGUE FRANCAISE, AND WAS APPROVED BY THE ATS BOARD OF DIRECTORS, JULY 1999. Am. J. Respir. Crit. Care Med. 160: 2118-2124 [Full Text]  
• Brook, A. D., Kollef, M. H. (1999). An Outcomes-Based Approach to Ventilatory Management: Review of Two Examples: Brook AD, Kollef MH An outcomes-based approach to ventilatory management review of two examples J Intensive Care Med 1999,14 262-274. J Intensive Care Med 14: 262-274  
• Cook, D. J., Sibbald, W. J. (1999). The promise and the paradox of technology in the intensive care unit. CMAJ 161: 1118-1119 [Full Text]  
• Rubenfeld, G. D., Caldwell, E., Granton, J., Hudson, L. D., Matthay, M. A. (1999). Interobserver Variability in Applying a Radiographic Definition for ARDS. Chest 116: 1347-1353 [Abstract] [Full Text]