About Careers Internship MedBlog Contact us

Better Outcomes On Mechanical Ventilation at Lower Level Among Patients Without Lung Injury

by Rukmani Krishna on October 30, 2012 at 11:38 PM
Font : A-A+

 Better Outcomes On Mechanical Ventilation at Lower Level Among Patients Without Lung Injury

According to an analysis, among patients without acute respiratory distress syndrome, protective mechanical ventilation with use of lower tidal volumes (the volume of air inhaled and exhaled during each breath) was associated with better outcomes including less lung injury, lower mortality, fewer pulmonary infections and a shorter hospital length of stay. The meta-analysis of previous studies was reported in the October 24/31 issue of JAMA.

"Mechanical ventilation is a life-saving strategy in patients with acute respiratory failure. However, unequivocal evidence suggests that mechanical ventilation has the potential to aggravate and precipitate lung injury. In acute respiratory distress syndrome (ARDS), and in a milder form of ARDS formerly known as acute lung injury (ALI), mechanical ventilation can cause ventilator-associated lung injury," according to background information in the article. "Lung-protective mechanical ventilation with the use of lower tidal volumes has been found to improve outcomes of patients with ARDS. It has been suggested that use of lower tidal volumes also benefits patients who do not have ARDS."


Ary Serpa Neto, M.D., M.Sc., of ABC Medical School, Santo Andre, Sao Paulo, Brazil and colleagues conducted a meta-analysis to determine whether conventional (higher) or protective (lower) tidal volumes would be associated with lung injury, mortality, and pulmonary infection in patients without lung injury at the onset of mechanical ventilation. After a search of the medical literature, the researchers identified 20 articles (2,822 participants) that met criteria for inclusion in the study.

Analysis of the data indicated a 67 percent decreased risk of lung injury development and 36 percent decrease in the risk of death in patients receiving ventilation with lower tidal volumes. The results of lung injury development were similar when stratified by the type of study (randomized vs. nonrandomized) and were significant only in randomized trials for pulmonary infection and only in nonrandomized trials for mortality. Analysis also showed, in protective ventilation groups, a lower incidence of pulmonary infection and lower average hospital length of stay (approximately 7 vs. 9 days, respectively).

"In conclusion, our meta-analysis suggests that among patients without lung injury, protective ventilation with use of lower tidal volumes at onset of mechanical ventilation may be associated with better clinical outcomes. We believe that clinical trials are needed to compare higher vs. lower tidal volumes in a heterogeneous group of patients receiving mechanical ventilation for longer periods," the authors write.

(JAMA. 2012;308[16]:1651-1659. Available pre-embargo to the media at http://media.jamanetwork.com)

Editor''s Note: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Editorial: Low Tidal Volumes for All?

In an accompanying editorial, Niall D. Ferguson, M.D., M.Sc., of Mount Sinai Hospital and the University of Toronto, writes that the "meta-analysis by Serpa Neto and colleagues serves as a convincing summary that the current knowledge base about low trial volume ventilation is inadequate."

"In addition to confirming or refuting the benefit of setting lower vs. higher tidal volumes in patients without ARDS, additional trials could address the degree of tidal volume limitation required, the patient populations that may benefit most, and whether to actively seek to limit tidal volumes in spontaneously breathing patients or simply avoid setting higher volumes. The role of intraoperative lung-protective ventilation also needs further study. Given the number of ICU patients receiving mechanical ventilation for whom this question applies (i.e., the 95 percent of patients who do not have ARDS at the time of intubation, such trials would have significant clinical importance and would be highly feasible."

Source: Newswise

News A-Z
What's New on Medindia
Quiz on Low-Calorie Diet for Diabetes
World Heart Day in 2022- Use Heart for Every Heart
Anemia among Indian Women and Children Remains a Cause of Concern- National Family Health Survey-5
View all
Recommended Reading
News Archive
News Category

Medindia Newsletters Subscribe to our Free Newsletters!
Terms & Conditions and Privacy Policy.

More News on:
Athletes Foot Pneumoconiosis Silicosis 

Most Popular on Medindia

Blood - Sugar Chart Find a Doctor Calculate Ideal Weight for Infants Blood Pressure Calculator Post-Nasal Drip A-Z Drug Brands in India Drug - Food Interactions Loram (2 mg) (Lorazepam) Indian Medical Journals Drug Interaction Checker
This site uses cookies to deliver our services. By using our site, you acknowledge that you have read and understand our Cookie Policy, Privacy Policy, and our Terms of Use

Better Outcomes On Mechanical Ventilation at Lower Level Among Patients Without Lung Injury Personalised Printable Document (PDF)

Please complete this form and we'll send you a personalised information that is requested

You may use this for your own reference or forward it to your friends.

Please use the information prudently. If you are not a medical doctor please remember to consult your healthcare provider as this information is not a substitute for professional advice.

Name *

Email Address *

Country *

Areas of Interests