Efficacy of Low Tidal Volume Ventilation in Patients with Different Clinical Risk Factors for Acute Lung Injury and the Acute Respiratory Distress Syndrome

• DOI: 10.1164/ajrccm.164.2.2011093
• Publication Date: 2013-04-04T18:45:45Z
• Authors: MARK D. EISNER; TAYLOR THOMPSON; LEONARD D. HUDSON; JOHN M. LUCE; DOUGLAS HAYDEN; DAVID SCHOENFELD; MICHAEL A. MATTHAY
• Keywords: Adult; Male; Respiratory Distress Syndrome; Multiple Organ Failure; Middle Aged; Respiration, Artificial; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Risk Factors; Multivariate Analysis; Tidal Volume; Humans; Female; Ventilator Weaning

In patients with acute lung injury (ALI) and respiratory distress syndrome (ARDS), a recent ARDS Network randomized controlled trial demonstrated that low tidal volume (Vt) mechanical ventilation strategy (6 ml/kg) reduced mortality by 22% compared traditional (12 ml/kg). this study, we examined the relative efficacy of Vt among 902 different clinical risk factors for ALI/ARDS who participated in trials. The factor was associated substantial variation mortality. death (before discharge home unassisted breathing) highest sepsis (43%); intermediate subjects pneumonia (36%), aspiration (37%), other (35%); lowest those trauma (11%) (p < 0.0001). Despite these differences mortality, there no evidence varied = 0.76, interaction between ventilator group factor). There also differential study outcomes: proportion achieving breathing 0.59), ventilator-free days 0.58), or development nonpulmonary organ failure 0.44). Controlling demographic covariates did not appreciably affect results. After reclassifying as pulmonary versus predisposing conditions infection-related non-infection-related conditions, still differed subgroups. conclusion, found subgroups ALI/ARDS.Keywords: syndrome; ventilators;