Abstract
Rationale: In a clinical trial by the Acute Respiratory Distress Syndrome Network (ARDSNet), mechanical ventilation with tidal volumes of 6 ml/kg decreased mortality from acute lung injury. However, interpretations of these results generatedcontroversyand it was unclear if this trial would change usual-care practices. Objectives: First, to determine if clinical practices at ARDSNet hospitals changed after the tidal volume trial. Second, to determine if tidal volume and plateau pressure (Pplat) within 48 hours before randomization affected hospital mortality in patients subsequently managed with 6 ml/kg predicted body weight (PBW). Methods: We used preenrollment data from 2,451 patients enrolled in six trials (1996-2005) to describe changes in tidal volume over time.Weused logistic regression to determine if preenrollment tidal volume or Pplat affected mortality. Measurements and Main Results: Median preenrollment tidal volume decreased from 10.3 ml/kg PBW (range, 4.3-17.1) during the tidal volume trial (1996-1999) to 7.3 ml/kg PBW (range, 3.9-16.2) after its completion (P < 0.001). Preenrollment tidal volume was not associated with mortality (P = 0.566). The odds of death increased multiplicatively with each cm H 2O of preenrollment Pplat (P<0.001) (e.g., the odds of death was 1.37 times greater when preenrollment Pplat increased by 10 cm H2O). Conclusions: Physicians used lower tidal volumes after publication of the tidal volume trial. Preenrollment Pplat was strongly associated with mortality, and may reflect disease severity independent of tidal volume. Pplat measured early in the course of acute lung injury, after accounting for tidal volume, is a respiratory system-specific value with strong prognostic significance.
Original language | English (US) |
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Pages (from-to) | 1215-1222 |
Number of pages | 8 |
Journal | American journal of respiratory and critical care medicine |
Volume | 177 |
Issue number | 11 |
DOIs | |
State | Published - Jun 1 2008 |
Keywords
- Acute lung injury
- Clinician practices
- Mechanical ventilation
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Critical Care and Intensive Care Medicine