Ventilation with lower tidal volumes versus traditional tidal volumes in adults for acute lung injury and acute respiratory distress syndrome.

摘要: Background Patients with acute respiratory distress syndrome (ARDS) and lung injury (ALI) require mechanical ventilatory support. ALI/ARDS is further complicated by ventilator-induced injury. Lung-protective ventilation strategies may lead to improved survival. Objectives To assess the effects of lower tidal volume (Vt) on morbidity mortality in adults patients affected ALI/ARDS. A secondary objective was determine whether comparison between low conventional Vt different if a plateau airway pressure greater than 30 35 cm H20 used. Search strategy We searched The Cochrane Central Register Controlled Trials (CENTRAL), Library issue 3, 2002; MEDLINE (1966 June 2002); EMBASE CINAHL (1982 intensive care journals conference proceedings; databases ongoing research, reference lists 'grey literature'. Selection criteria Randomized trials comparing using and/or driving (plateau H2O or less), resulting 7 ml/kg less versus that uses range 10 15 ml/kg, (16 year-old greater). Data collection analysis Two reviewers independently assessed trial quality extracted data. Wherever appropriate, results were pooled. Fixed random models applied. Main Five trials, involving 1202 patients, eligible. test for heterogeneity gave P-value 0.12. Ventilation associated decreased at end follow up period each trial: 216/605 (35.7%) 249/597 (41.7%), relative risk (RR) 0.85 (CI 0.74 0.98). effect intervention not statistically significant when model used: RR 0.91 0.72 1.14). Mortality day 28 significantly reduced lung-protective ventilation: 0.61 0.88). equal 31 control group 1.13 0.88 1.45). There insufficient evidence about long term outcomes. Reviewer's conclusions Clinical heterogeneity, such as lengths higher arms two make interpretation combined difficult. are uncertain, although possibility clinically relevant benefit cannot be excluded. no beneficial where hypercapnia potentially harmful.