Tidal volume reduction in patients with acute lung injury when plateau pressures are not high

David N. Hager, Jerry A. Krishnan, Douglas L. Hayden, Roy G. Brower

Research output: Contribution to journalReview articlepeer-review

Abstract

Use of a volume- and pressure-limited mechanical ventilation strategy improves clinical outcomes of patients with acute lung injury and acute respiratory distress syndrome (ALI/ARDS). However, the extent to which tidal volumes and inspiratory airway pressures should be reduced to optimize clinical outcomes is a controversial topic. This article addresses the question, "Is there a safe upper limit to inspiratory plateau pressure in patients with ALI/ARDS?" We reviewed data from animal models with and without preexisting lung injury, studies of normal human respiratory system mechanics, and the results of five clinical trials of lung-protective mechanical ventilation strategies. We also present an original analysis of data from the largest of the five clinical trials. The available data from each of these assessments do not support the commonly held view that inspiratory plateau pressures of 30 to 35 cm H2O are safe. We could not identify a safe upper limit for plateau pressures in patients with ALI/ARDS.

Original languageEnglish (US)
Pages (from-to)1241-1245
Number of pages5
JournalAmerican journal of respiratory and critical care medicine
Volume172
Issue number10
DOIs
StatePublished - Nov 15 2005
Externally publishedYes

Keywords

  • Acute lung injury
  • Acute respiratory distress syndrome
  • Mechanical ventilation
  • Plateau

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Fingerprint Dive into the research topics of 'Tidal volume reduction in patients with acute lung injury when plateau pressures are not high'. Together they form a unique fingerprint.

Cite this