Written by Clay Smith
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In patients with respiratory distress but not ARDS, a low tidal volume (VT) vs intermediate VT strategy did not reduce ventilator-free days or other outcomes, such as 28 or 90-day mortality.
Why does this matter?
We know in patients with ARDS that a low tidal volume ventilation strategy reduced mortality, but does that hold true for patients with non-ARDS respiratory failure? See this post, based on Scott Weingart’s review in Annals of EM, and learn to Manage the Vent Like a Pro.
Does this PReVENT complications?
This was a multicenter RCT with 961 patients with acute respiratory distress requiring mechanical ventilation but not having ARDS. They were randomized to either low VT, 6mL/kg, or intermediate VT, 8mL/kg, strategy. There was no difference in ventilator free days, with each group having a median 21 ventilator-free days. The pCO2 was higher and pH lower in the low VT group. There was also no difference in any secondary outcomes: mortality, ICU days, hospital days, development of ARDS, pneumothorax, etc. What this means for my practice is that I don’t need to use a strict low VT ventilation strategy with non-ARDS patients. A good starting VT is 8mL/kg in most patients. Move toward 6mL/kg in ARDS patients, and in others, just leave it at 8mL/kg.
Another Spoonful
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The Bottom Line did an in depth summary.
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The Resus Room covers this article and more in audio form.
Source
Effect of a Low vs Intermediate Tidal Volume Strategy on Ventilator-Free Days in Intensive Care Unit Patients Without ARDS: A Randomized Clinical Trial. JAMA. 2018 Nov 13;320(18):1872-1880. doi: 10.1001/jama.2018.14280.
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