Low Tidal Volume Ventilation in Acute Respiratory Distress Syndrome
Matthew G. Gartland
Brian M. Cummings
Ventilation With Lower Tidal Volumes as Compared With Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome
The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000;342(18):1301–1308
Background
Acute respiratory distress syndrome (ARDS) and acute lung injury (ALI), now called mild ARDS, carry high mortality in adults and children. Traditional mechanical ventilation strategies to maximize oxygenation and achieve normal values of pH and partial pressure of CO2 (PaCO2) in ARDS used physiologic or larger tidal volumes (TVs). However, potential harms demonstrated in animal models included lung stretch injury (volutrauma) and barotrauma, possibly due to high positive pressures. Prior to this study, the impact of lung injury in human trials was inconclusive.
Objectives
To assess whether lower TV ventilation improves mortality in adults with ARDS.
Methods
Randomized controlled trial at 10 US centers from 1996 to 1999.
Patients
861 patients ages 18 to 70 years with ARDS and ALI, defined as acute decrease in the ratio of partial pressure of arterial oxygen (PaO2) to fraction of inspired oxygen (FiO2) to <300, chest x-ray with bilateral infiltrates, and no evidence of left atrial hypertension. Select exclusion criterion: life expectancy <6 months.
Intervention
With volume-control mode, traditional group received ∼12 mL/kg TV with plateau pressure <50 cm H2O and low TV group received ∼6 mL/kg with plateau pressures <30 cm H2O.
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