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Crit Care Med. 2015 Oct;43(10):2155-63. doi: 10.1097/CCM.0000000000001189.

Lung-Protective Ventilation With Low Tidal Volumes and the Occurrence of Pulmonary Complications in Patients Without Acute Respiratory Distress Syndrome: A Systematic Review and Individual Patient Data Analysis.

Author information

1
1Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 2Program of Post-Graduation, Research and Innovation, Faculdade de Medicina do ABC (FMABC), Santo André, Brazil. 3Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil. 4Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. 5Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA. 6School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. 7Department of Anaesthesia and Intensive Care Medicine, Helsinki University Hospital, Peijas Hospital, Vantaa, Finland. 8Medical School, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil. 9Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA. 10Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. 11Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino IST, University of Genoa, Genoa, Italy. 12Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

Abstract

OBJECTIVE:

Protective mechanical ventilation with low tidal volumes is standard of care for patients with acute respiratory distress syndrome. The aim of this individual patient data analysis was to determine the association between tidal volume and the occurrence of pulmonary complications in ICU patients without acute respiratory distress syndrome and the association between occurrence of pulmonary complications and outcome in these patients.

DESIGN:

Individual patient data analysis.

PATIENTS:

ICU patients not fulfilling the consensus criteria for acute respiratory distress syndrome at the onset of ventilation.

INTERVENTIONS:

Mechanical ventilation with low tidal volume.

MEASUREMENTS AND MAIN RESULTS:

The primary endpoint was development of a composite of acute respiratory distress syndrome and pneumonia during hospital stay. Based on the tertiles of tidal volume size in the first 2 days of ventilation, patients were assigned to a "low tidal volume group" (tidal volumes ≤ 7 mL/kg predicted body weight), an "intermediate tidal volume group" (> 7 and < 10 mL/kg predicted body weight), and a "high tidal volume group" (≥ 10 mL/kg predicted body weight). Seven investigations (2,184 patients) were included. Acute respiratory distress syndrome or pneumonia occurred in 23% of patients in the low tidal volume group, in 28% of patients in the intermediate tidal volume group, and in 31% of the patients in the high tidal volume group (adjusted odds ratio [low vs high tidal volume group], 0.72; 95% CI, 0.52-0.98; p = 0.042). Occurrence of pulmonary complications was associated with a lower number of ICU-free and hospital-free days and alive at day 28 (10.0 ± 10.9 vs 13.8 ± 11.6 d; p < 0.01 and 6.1 ± 8.1 vs 8.9 ± 9.4 d; p < 0.01) and an increased hospital mortality (49.5% vs 35.6%; p < 0.01).

CONCLUSIONS:

Ventilation with low tidal volumes is associated with a lower risk of development of pulmonary complications in patients without acute respiratory distress syndrome.

PMID:
26181219
DOI:
10.1097/CCM.0000000000001189
[Indexed for MEDLINE]

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