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

Ary Serpa Neto, Fabienne D. Simonis, Carmen S.V. Barbas, Michelle Biehl, Rogier M. Determann, Jonathan Elmer, Gilberto Friedman, Ognjen Gajic, Joshua N. Goldstein, Rita Linko, Roselaine Pinheiro De Oliveira, Sugantha Sundar, Daniel Talmor, Esther K. Wolthuis, Marcelo Gama De Abreu, Paolo Pelosi, Marcus J. Schultz, for the PROtective Ventilation Network Investigators

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128 Citations (Scopus)


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,; 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.

Original languageEnglish
Pages (from-to)2155-2163
Number of pages9
JournalCritical Care Medicine
Issue number10
Publication statusPublished - Oct 2015
Externally publishedYes


  • Acute respiratory distress syndrome
  • Individual patient analysis
  • Intensive care unit and in-hospital stay
  • Mechanical ventilation
  • Mortality
  • Pulmonary complications
  • Tidal volume

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