Format

Send to

Choose Destination
Am J Respir Crit Care Med. 2005 Nov 15;172(10):1241-5. Epub 2005 Aug 4.

Tidal volume reduction in patients with acute lung injury when plateau pressures are not high.

Author information

1
Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. dhager1@jhmi.edu

Abstract

Use of a volume- and pressure-limited mechanical ventilation strategy improves clinical outcomes of patients with acute lung injury and acute respiratory distress syndrome (ALI/ARDS). However, the extent to which tidal volumes and inspiratory airway pressures should be reduced to optimize clinical outcomes is a controversial topic. This article addresses the question, "Is there a safe upper limit to inspiratory plateau pressure in patients with ALI/ARDS?" We reviewed data from animal models with and without preexisting lung injury, studies of normal human respiratory system mechanics, and the results of five clinical trials of lung-protective mechanical ventilation strategies. We also present an original analysis of data from the largest of the five clinical trials. The available data from each of these assessments do not support the commonly held view that inspiratory plateau pressures of 30 to 35 cm H2O are safe. We could not identify a safe upper limit for plateau pressures in patients with ALI/ARDS.

PMID:
16081547
PMCID:
PMC2718413
DOI:
10.1164/rccm.200501-048CP
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Atypon Icon for PubMed Central
Loading ...
Support Center