BACKGROUND: Low tidal volumes have been associated with improved outcomes in patients with established acute lung injury. The role of low tidal volume ventilation in patients without lung injury is still unresolved. We hypothesized that such a strategy in patients undergoing elective surgery would reduce ventilator-associated lung injury and that this improvement would lead to a shortened time to extubation METHODS: A single-center randomized controlled trial was undertaken in 149 patients undergoing elective cardiac surgery. Ventilation with 6 versus 10 ml/kg tidal volume was compared. Ventilator settings were applied immediately after anesthesia induction and continued throughout surgery and the subsequent intensive care unit stay. The primary endpoint of the study was time to extubation. Secondary endpoints included the proportion of patients extubated at 6 h and indices of lung mechanics and gas exchange as well as patient clinical outcomes. RESULTS:Median ventilation time was not significantly different in the low tidal volume group; a median (interquartile range) of 450 (264-1,044) min was achieved compared with 643 (417-1,032) min in the control group (P = 0.10). However, a higher proportion of patients in the low tidal volume group was free of any ventilation at 6 h: 37.3% compared with 20.3% in the control group (P = 0.02). In addition, fewer patients in the low tidal volume group required reintubation (1.3 vs. 9.5%; P = 0.03). CONCLUSIONS: Although reduction of tidal volume in mechanically ventilated patients undergoing elective cardiac surgery did not significantly shorten time to extubation, several improvements were observed in secondary outcomes. When these data are combined with a lack of observed complications, a strategy of reduced tidal volume could still be beneficial in this patient population.
RCT Entities:
BACKGROUND: Low tidal volumes have been associated with improved outcomes in patients with established acute lung injury. The role of low tidal volume ventilation in patients without lung injury is still unresolved. We hypothesized that such a strategy in patients undergoing elective surgery would reduce ventilator-associated lung injury and that this improvement would lead to a shortened time to extubation METHODS: A single-center randomized controlled trial was undertaken in 149 patients undergoing elective cardiac surgery. Ventilation with 6 versus 10 ml/kg tidal volume was compared. Ventilator settings were applied immediately after anesthesia induction and continued throughout surgery and the subsequent intensive care unit stay. The primary endpoint of the study was time to extubation. Secondary endpoints included the proportion of patients extubated at 6 h and indices of lung mechanics and gas exchange as well as patient clinical outcomes. RESULTS: Median ventilation time was not significantly different in the low tidal volume group; a median (interquartile range) of 450 (264-1,044) min was achieved compared with 643 (417-1,032) min in the control group (P = 0.10). However, a higher proportion of patients in the low tidal volume group was free of any ventilation at 6 h: 37.3% compared with 20.3% in the control group (P = 0.02). In addition, fewer patients in the low tidal volume group required reintubation (1.3 vs. 9.5%; P = 0.03). CONCLUSIONS: Although reduction of tidal volume in mechanically ventilated patients undergoing elective cardiac surgery did not significantly shorten time to extubation, several improvements were observed in secondary outcomes. When these data are combined with a lack of observed complications, a strategy of reduced tidal volume could still be beneficial in this patient population.
Authors: Gunjan Y Gandhi; Gregory A Nuttall; Martin D Abel; Charles J Mullany; Hartzell V Schaff; Peter C O'Brien; Matthew G Johnson; Arthur R Williams; Susanne M Cutshall; Lisa M Mundy; Robert A Rizza; M Molly McMahon Journal: Ann Intern Med Date: 2007-02-20 Impact factor: 25.391
Authors: Esther K Wolthuis; Goda Choi; Mark C Dessing; Paul Bresser; Rene Lutter; Misa Dzoljic; Tom van der Poll; Margreeth B Vroom; Markus Hollmann; Marcus J Schultz Journal: Anesthesiology Date: 2008-01 Impact factor: 7.892
Authors: Alysson R Carvalho; Fumito Ichinose; Ivany A Schettino; Dean Hess; Javier Rojas; Antonio Giannella-Neto; Arvind Agnihotri; Jennifer Walker; Thomas E MacGillivray; Marcos F Vidal Melo Journal: Lung Date: 2011-09-28 Impact factor: 2.584
Authors: Ary Serpa Neto; Fabienne D Simonis; Carmen S V Barbas; Michelle Biehl; Rogier M Determann; Jonathan Elmer; Gilberto Friedman; Ognjen Gajic; Joshua N Goldstein; Janneke Horn; Nicole P Juffermans; Rita Linko; Roselaine Pinheiro de Oliveira; Sugantha Sundar; Daniel Talmor; Esther K Wolthuis; Marcelo Gama de Abreu; Paolo Pelosi; Marcus J Schultz Journal: Intensive Care Med Date: 2014-05-09 Impact factor: 17.440
Authors: Mauro R Tucci; Eduardo L V Costa; Tyler J Wellman; Guido Musch; Tilo Winkler; R Scott Harris; Jose G Venegas; Marcelo B P Amato; Marcos F Vidal Melo Journal: Anesthesiology Date: 2013-07 Impact factor: 7.892
Authors: Gabrielle E Hatton; Patrick J Mollett; Reginald E Du; Shuyan Wei; Radha Korupolu; Charles E Wade; Sasha D Adams; Lillian S Kao Journal: J Spinal Cord Med Date: 2020-02-11 Impact factor: 1.985