Chest
Are Low Tidal Volumes Safe?
Section snippets
METHODS
This study was approved by the Committee on the Protection of Human Subjects in Research at the University of Massachusetts Medical Center, Worcester. Verbal informed consent was obtained from patients or responsible third parties within 24 h of entry into the trial.
All patients requiring mechanical ventilation in the surgical intensive care unit (SICU), except those recovering from cardiac surgery, were eligible for entry into the trial. Excluded after the trial was already under way were 33
RESULTS
One hundred three patients were entered into the trial from October 1987 through February 1988. As shown in Table 1 and Figure 1, the groups were quite comparable in terms of age, sex, and severity of illness (as estimated by APACHE-II score). Age was bimodally distributed in both groups, the younger peak representing primarily patients admitted to the SICU after major trauma. The primary diagnoses necessitating admission to the SICU were similar in both groups (Table 1).
Pulmonary function data
DISCUSSION
The data presented herein support the idea that routine use of low VT is safe in SICU patients. Furthermore, our results suggest that the incidence of pulmonary infections may be decreased by using low VT, although this somewhat surprising observation needs to be confirmed in a larger study designed to specifically address this issue.
Questioning the necessity for moderate to large VT (10 to 15 ml/kg) is somewhat heretical. Why were our results different from those obtained by Bendixen et al?4
ACKNOWLEDGMENTS
We gratefully acknowledge the support of the Surgical Intensive Care Unit nurses at the University of Massachusetts Medical Center. Stephen O. Heard, M.D., reviewed the manuscript and provided us with insightful and informative guidance. Carol Powers retrieved dozens of charts from medical records. Sandy Hinson, Penny Lucier, and Michelle Tremblay assisted in preparation of the manuscript.
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Cited by (102)
Low Tidal Volumes for Everyone?
2019, ChestCitation Excerpt :In a study from the early 1990s, intubated patients in a surgical ICU were randomly assigned to VT settings of 12 mL/kg vs 6 mL/kg PBW. The investigators found that the routine use of low VT settings seemed to be safe.54 Indeed, among patients without ARDS who were ventilated, protective ventilation with lower VT settings was associated with better clinical outcomes.55
Ventilator associated pneumonia and tracheostomy
2015, Trends in Anaesthesia and Critical CareCitation Excerpt :Mortality was not affect by timing of tracheostomy in these patients. It has been shown that protective ventilation strategy, with the application of positive end expiratory pressure (PEEP) [41] and low tidal volume ventilation reduces the risk of bacterial growth and VAP [42,43], and could be recommended also for patient without ARDS [44], suggesting that not only devices, but also the quality of ventilation itself plays an important role [45,46]. Mechanism seems to be related to the reduction of cyclic stretch of lung cells, reducing inflammation and acidification [42].
Prevention of Postoperative Pulmonary Complications
2015, Surgical Clinics of North AmericaCitation Excerpt :There is strong evidence for the beneficial use of lower tidal volumes among patients with ALI, and all patients requiring mechanical ventilation may benefit from this strategy.65,66 General surgical patients who undergo intraoperative mechanical ventilation with lower tidal volumes have lower levels of circulating inflammatory cytokines postoperatively67 and may have a lower instance of pneumonia.68 However, randomized studies to date fail to show major benefits of low intraoperative tidal volume strategies and a consensus is lacking.11,66,69
Mechanical ventilation of the healthy lungs: Lessons learned from recent trials
2021, Current Opinion in Critical Care
Manuscript received December 16; revision accepted July 13.