Effects of a clinical trial on mechanical ventilation practices in patients with acute lung injury

William Checkley, Roy G Brower, Anna Korpak, B. Taylor Thompson

Research output: Contribution to journalArticle

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 (P2O). 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 languageEnglish (US)
Pages (from-to)1215-1222
Number of pages8
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume177
Issue number11
DOIs
StatePublished - Jun 1 2008

Fingerprint

Acute Lung Injury
Tidal Volume
Artificial Respiration
Clinical Trials
Mortality
Adult Respiratory Distress Syndrome
Body Weight
Random Allocation
Hospital Mortality
Respiratory System
Publications
Logistic Models

Keywords

  • Acute lung injury
  • Clinician practices
  • Mechanical ventilation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Effects of a clinical trial on mechanical ventilation practices in patients with acute lung injury. / Checkley, William; Brower, Roy G; Korpak, Anna; Thompson, B. Taylor.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 177, No. 11, 01.06.2008, p. 1215-1222.

Research output: Contribution to journalArticle

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AB - 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 (P2O). 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.

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