|Tidal volume restriction fails to show benefit in non-ARDS patients|
|Lung-protective ventilation using a low tidal volume has been widely applied to intensive care unit (ICU) patients with acute respiratory distress syndrome (ARDS), which has improved those patients’ outcome. However, whether the low tidal volume strategy is suitable for non-ARDS patients requiring mechanical ventilation is still being debated. Studies have shown that tidal volume restriction reduces the incidence of pulmonary complications and shortens the durations on the ventilator and hospital/ICU stay. However, other trials have been shown to increase the dose of sedation and the risk of delirium. In order to test the hypothesis that vital volume reduction would reduce the ventilator-free duration and improve the survival at day 28 among non-ARDS ICU patients, the PreVENT investigators from the Netherlands published their results of this multiple-centred randomized trial in a recent issue of the Journal of American Medical Association (JAMA, here).
Non-ARDS patients requiring mechanical ventilation were recruited in the trial from 6 institutions across the Netherlands. A total of 961 patients were enrolled in the study: 477 patients received a tidal volume of 6ml/kg predicted body weight and then a reduced tidal volume of 4ml/kg predicted body weight (the low tidal volume group); 484 patients started with a tidal volume of 10ml/kg predicted body weight (the intermediate tidal volume group). The primary endpoint of this study was the ventilator-free duration and survival at day 28. Patients in both groups had a median of 21 ventilator-free days. No differences in the length of ICU stay (a median of 6 days in both groups) and hospital stay (a median of 14 days in the low tidal volume group, and a median of 15 days in the intermediate tidal volume group) were observed between the groups. The mortality at 28 and 90 days was not significant between the two groups. No significance of ventilation-related complications, including ARDS, pneumonia, severe atelectasis, and pneumothorax, was indicated between the groups.
This trial demonstrates that the low tidal volume strategy does not show any benefit in non-ARDS ICU patients that require mechanical ventilation.