Document Detail


Tidal volume reduction in patients with acute lung injury when plateau pressures are not high.
MedLine Citation:
PMID:  16081547     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Use of a volume- and pressure-limited mechanical ventilation strategy improves clinical outcomes of patients with acute lung injury and acute respiratory distress syndrome (ALI/ARDS). However, the extent to which tidal volumes and inspiratory airway pressures should be reduced to optimize clinical outcomes is a controversial topic. This article addresses the question, "Is there a safe upper limit to inspiratory plateau pressure in patients with ALI/ARDS?" We reviewed data from animal models with and without preexisting lung injury, studies of normal human respiratory system mechanics, and the results of five clinical trials of lung-protective mechanical ventilation strategies. We also present an original analysis of data from the largest of the five clinical trials. The available data from each of these assessments do not support the commonly held view that inspiratory plateau pressures of 30 to 35 cm H2O are safe. We could not identify a safe upper limit for plateau pressures in patients with ALI/ARDS.
Authors:
David N Hager; Jerry A Krishnan; Douglas L Hayden; Roy G Brower;
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Review     Date:  2005-08-04
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  172     ISSN:  1073-449X     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-11-08     Completed Date:  2006-07-05     Revised Date:  2013-06-09    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1241-5     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. dhager1@jhmi.edu
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MeSH Terms
Descriptor/Qualifier:
Animals
Humans
Logistic Models
Models, Animal
Respiration, Artificial / methods*
Respiratory Distress Syndrome, Adult / physiopathology,  therapy*
Tidal Volume
Grant Support
ID/Acronym/Agency:
F32-HL078132/HL/NHLBI NIH HHS; K23-HL67850/HL/NHLBI NIH HHS; N01-HR46063/HR/NHLBI NIH HHS; N01-HR46064/HR/NHLBI NIH HHS; P50-HL073944/HL/NHLBI NIH HHS
Comments/Corrections
Comment In:
Am J Respir Crit Care Med. 2006 Mar 15;173(6):686; author reply 687   [PMID:  16522769 ]
Am J Respir Crit Care Med. 2006 Mar 15;173(6):685-6; author reply 687   [PMID:  16522768 ]

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