JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (12) Citing Articles via Google Scholar Google Scholar Articles by Petrucci, N. Articles by Iacovelli, W. Search for Related Content PubMed PubMed Citation Articles by Petrucci, N. Articles by Iacovelli, W. Related Collections Critical Care Trauma

---

CRITICAL CARE AND TRAUMA

Ventilation with Smaller Tidal Volumes: A Quantitative Systematic Review of Randomized Controlled Trials

Department of Anaesthesia & Intensive Care, Azienda Ospedaliera Desenzano, Desenzano, Italy

Address correspondence and reprint requests to Dr. Nicola Petrucci, MD MSc, Department of Anesthesia and Intensive Care, Azienda Ospedaliera Desenzano, Loc. Montecroce, 25015 Desenzano (BS), Italy. Address email to n.petrucci{at}libero.it

In this quantitative systematic review we assessed the effects of ventilation with smaller tidal volume (VT) on morbidity and mortality in patients aged 16 yr or older affected by acute lung injury and acute respiratory distress syndrome. Five randomized trials (1202 patients) comparing ventilation using smaller VT and/or low airway driving pressure (plateau pressure 30 cm H₂O or less), resulting in VT of 7 mL/kg or less versus ventilation that uses VT in the range of 10 to 15 mL/kg, were identified after a systematic search of The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, databases of current research, reference lists, and "gray literature." Mortality at day 28 was significantly reduced by lung-protective ventilation (relative risk [RR], 0.74; confidence interval [CI], 0.61–0.88), whereas beneficial effect on long-term mortality was uncertain (RR, 0.84; CI, 0.68–1.05). The comparison between small and conventional VT was not significantly different if a plateau pressure less than or equal to 31 cm H₂O in the control group was used (RR, 1.13; CI, 0.88–1.45). Clinical heterogeneity, such as different lengths of follow-up and higher plateau pressures in control arms in two trials, make the interpretation of the combined results difficult.

IMPLICATIONS: Mechanical breathing can cause lung damage and bleeding in patients affected by severe lung failure. This systematic review summarizes clinical trials testing a lung-protective method of mechanical ventilation. Protective ventilation can decrease deaths in the short term but the effects in the long term are unknown.

This article has been cited by other articles:

				E. Fan, D. M. Needham, and T. E. Stewart Ventilatory Management of Acute Lung Injury and Acute Respiratory Distress Syndrome JAMA, December 14, 2005; 294(22): 2889 - 2896. [Abstract] [Full Text] [PDF]

				T. T. Horlocker and D. R. Brown Evidence-Based Medicine: Haute Couture or the Emperor's New Clothes? Anesth. Analg., June 1, 2005; 100(6): 1807 - 1810. [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999