OBJECTIVES: A recent randomized trial of mechanical ventilation in acute lung injury (ALI)/adult respiratory distress syndrome (ARDS) demonstrated a 22% relative reduction in mortality rate using 6 mL/kg predicted body weighttidal volume vs. 12 mL/kg predicted body weighttidal volume. We determined whether publication of these findings changed clinical practice. DESIGN: Retrospective cohort, 12 months before (Pre) and 12 months after publication (Post) of a randomized trial supporting the use of a 6 mL/kg predicted body weighttidal volume strategy. SETTING:Three tertiary care hospitals in northern New England. PATIENTS: From a sample of 943 patients receiving prolonged mechanical ventilation between 1998 and 1999 (Pre) and between 2000 and 2001 (Post), 300 patients meeting the American-European Consensus Conference definition of ALI or ARDS were selected for analysis. INTERVENTIONS: The tidal volume, tidal volume/kg predicted body weight, and proportion receiving tidal volume/kg >; or =6 mL/kg and < or =12 mL/kg predicted body weight were recorded at noon the first day after the diagnosis of ALI or ARDS was established. MEASUREMENTS AND MAIN RESULTS:Pre and Post mean tidal volume (+/- sd) size and tidal volume size/kg predicted body weight were 759 +/- 158 mL (median 750 mL) vs. 639 +/- 138 mL (median 600 mL, p <.001) and 12.3 +/- 2.7 mL/kg (median 11.7 mL/kg) vs. 10.6 +/- 2.4 mL/kg (median 10.7 mL/kg, p <.001) respectively. Pre and Post plateau pressures and peak airway pressures were similar. CONCLUSION: Publication of a trial demonstrating large mortality reductions using small tidal volume was associated with significant reductions in tidal volume delivered to patients with ALI/ARDS. However, wide variation in practice persists, and the proportion of patients receiving tidal volumes within recommended limits (< or =8 mL/kg) remains modest.
RCT Entities:
OBJECTIVES: A recent randomized trial of mechanical ventilation in acute lung injury (ALI)/adult respiratory distress syndrome (ARDS) demonstrated a 22% relative reduction in mortality rate using 6 mL/kg predicted body weight tidal volume vs. 12 mL/kg predicted body weight tidal volume. We determined whether publication of these findings changed clinical practice. DESIGN: Retrospective cohort, 12 months before (Pre) and 12 months after publication (Post) of a randomized trial supporting the use of a 6 mL/kg predicted body weight tidal volume strategy. SETTING: Three tertiary care hospitals in northern New England. PATIENTS: From a sample of 943 patients receiving prolonged mechanical ventilation between 1998 and 1999 (Pre) and between 2000 and 2001 (Post), 300 patients meeting the American-European Consensus Conference definition of ALI or ARDS were selected for analysis. INTERVENTIONS: The tidal volume, tidal volume/kg predicted body weight, and proportion receiving tidal volume/kg > or =6 mL/kg and < or =12 mL/kg predicted body weight were recorded at noon the first day after the diagnosis of ALI or ARDS was established. MEASUREMENTS AND MAIN RESULTS: Pre and Post mean tidal volume (+/- sd) size and tidal volume size/kg predicted body weight were 759 +/- 158 mL (median 750 mL) vs. 639 +/- 138 mL (median 600 mL, p <.001) and 12.3 +/- 2.7 mL/kg (median 11.7 mL/kg) vs. 10.6 +/- 2.4 mL/kg (median 10.7 mL/kg, p <.001) respectively. Pre and Post plateau pressures and peak airway pressures were similar. CONCLUSION: Publication of a trial demonstrating large mortality reductions using small tidal volume was associated with significant reductions in tidal volume delivered to patients with ALI/ARDS. However, wide variation in practice persists, and the proportion of patients receiving tidal volumes within recommended limits (< or =8 mL/kg) remains modest.
Authors: Sari Karlsson; Marjut Varpula; Esko Ruokonen; Ville Pettilä; Ilkka Parviainen; Tero I Ala-Kokko; Elina Kolho; Esa M Rintala Journal: Intensive Care Med Date: 2007-01-16 Impact factor: 17.440
Authors: D Sorenson; C K Grissom; L Carpenter; A Austin; K Sward; L Napoli; H R Warner; A H Morris Journal: J Biomed Inform Date: 2008-02-21 Impact factor: 6.317
Authors: Steven Y Chang; Ousama Dabbagh; Ognen Gajic; Amee Patrawalla; Marie-Carmelle Elie; Daniel S Talmor; Atul Malhotra; Adebola Adesanya; Harry L Anderson; James M Blum; Pauline K Park; Michelle Ng Gong Journal: Respir Care Date: 2013-04 Impact factor: 2.258