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Research ArticleConference Proceedings

Should Tidal Volume Be 6 mL/kg Predicted Body Weight in Virtually All Patients With Acute Respiratory Failure?

Kenneth P Steinberg and Robert M Kacmarek
Respiratory Care May 2007, 52 (5) 556-567;
Kenneth P Steinberg
Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, Washington.
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Robert M Kacmarek
Respiratory Care Services, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts.
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Abstract

Over the last 2 decades, it has become clear that mechanical ventilation itself can cause lung injury and affect outcome. The development of ventilator-induced lung injury is strongly associated with overdistension of lung parenchyma, and limiting lung stretch saves lives in patients with acute lung injury. The debate in this paper is whether all patients on mechanical ventilation should be managed with a tidal volume (VT) of 6 mL/kg predicted body weight. Current data indicate that reducing lung stretch should be the standard for all patients with acute lung injury and acute respiratory distress syndrome who require ventilatory support. However, insufficient data exist to indicate that a VT of 6 mL/kg predicted body weight should be the standard for all patients who require mechanical ventilation. Whether VT is the correct target for therapeutic interventions is debatable. Plateau pressure may be a better target for assessing and preventing alveolar overdistension. As the data evolve, it is conceivable that the actual VT used should be based on the individual patient's lung mechanics rather than assuming that one VT will suit all patients. Consensus at this time is not possible, and this paper presents the arguments on both sides of the controversy.

  • tidal volume
  • mechanical ventilation
  • acute lung injury
  • acute respiratory distress syndrome

Footnotes

  • Correspondence: Kenneth P Steinberg MD, Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, 325 Ninth Avenue, Box 359762, Seattle WA 98104. E-mail: steinkp{at}u.washington.edu.
  • Copyright © 2007 by Daedalus Enterprises Inc.
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Respiratory Care: 52 (5)
Respiratory Care
Vol. 52, Issue 5
1 May 2007
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Should Tidal Volume Be 6 mL/kg Predicted Body Weight in Virtually All Patients With Acute Respiratory Failure?
Kenneth P Steinberg, Robert M Kacmarek
Respiratory Care May 2007, 52 (5) 556-567;

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Should Tidal Volume Be 6 mL/kg Predicted Body Weight in Virtually All Patients With Acute Respiratory Failure?
Kenneth P Steinberg, Robert M Kacmarek
Respiratory Care May 2007, 52 (5) 556-567;
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  • tidal volume
  • mechanical ventilation
  • acute lung injury
  • Acute Respiratory Distress Syndrome

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