TY - JOUR
T1 - Lung-protective ventilation with low tidal volumes and the occurrence of pulmonary complications in patients without acute respiratory distress syndrome
T2 - A systematic review and individual patient data analysis
AU - Neto, Ary Serpa
AU - Simonis, Fabienne D.
AU - Barbas, Carmen S.V.
AU - Biehl, Michelle
AU - Determann, Rogier M.
AU - Elmer, Jonathan
AU - Friedman, Gilberto
AU - Gajic, Ognjen
AU - Goldstein, Joshua N.
AU - Linko, Rita
AU - De Oliveira, Roselaine Pinheiro
AU - Sundar, Sugantha
AU - Talmor, Daniel
AU - Wolthuis, Esther K.
AU - De Abreu, Marcelo Gama
AU - Pelosi, Paolo
AU - Schultz, Marcus J.
AU - for the PROtective Ventilation Network Investigators
PY - 2015/10
Y1 - 2015/10
N2 - 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.
AB - 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.
KW - Acute respiratory distress syndrome
KW - Individual patient analysis
KW - Intensive care unit and in-hospital stay
KW - Mechanical ventilation
KW - Mortality
KW - Pulmonary complications
KW - Tidal volume
UR - http://www.scopus.com/inward/record.url?scp=84941896522&partnerID=8YFLogxK
U2 - 10.1097/CCM.0000000000001189
DO - 10.1097/CCM.0000000000001189
M3 - Review Article
C2 - 26181219
AN - SCOPUS:84941896522
SN - 0090-3493
VL - 43
SP - 2155
EP - 2163
JO - Critical Care Medicine
JF - Critical Care Medicine
IS - 10
ER -