Effect of lung-protective ventilation with lower tidal volumes on clinical outcomes among patients undergoing surgery: a meta-analysis of randomized controlled trials

Gu, Wan‐Jie; Wang, Fei; Liu, Jingchen

doi:10.1503/cmaj.141005

Cited by 53 publications

(43 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is important to note that in these animal experiments the time-dependent MB P was applied when the lungs were still clinically normal (41,(111)(112)(113). Thus these studies support the clinical evidence that early application of low VT and PEEP will reduce ARDS incidence in high-risk patients undergoing surgery or receiving care in an ICU (58,119).…”

Section: Synthesis Reviewsupporting

confidence: 65%

“…These studies illustrate four key concepts: 1) mortality in patients with established ARDS remains unacceptably high even with low VT ventilation (105,131,134); 2) improperly adjusted mechanical ventilation can exacerbate EALI in patients at high risk and thus increase ARDS incidence (73); 3) preemptive application of a protective ventilation strategy in this same high-risk group of patients can significantly reduce ARDS incidence (7,35,49,50,52,53,58,66,72,119); and 4) the optimally protective breath necessary to block progressive ALI remains to be determined.…”

Section: Mechanical Ventilation and The Incidence Of Ardsmentioning

confidence: 99%

“…An inappropriately set MB P can exacerbate lung fluid flux by multiple mechanisms, which would explain the ventilator-dependent increase in ARDS mortality (8). Conversely, appropriately adjusted ventilation can minimize stress concentrators (104, 109) and dynamic strain (68,69) and has been shown to reduce ARDS incidence (58,119). Thus is it possible that parameters in the MB P can be set to not only minimize microstrain but to concurrently reduce edema formation?…”

Section: Physiological Evidence That the Mechanical Breath Can Block mentioning

confidence: 99%

“…Multiple studies have shown that a combination of low VT, recruitment maneuvers, and PEEP do reduce the incidence of ARDS among high-risk patients undergoing surgery or being cared for in an ICU (7,35,49,50,52,53,58,66,72,119). The low VT breath should reduce dynamic alveolar strain but it may not be as effective as HFOV at homogeneous lung ventilation (which would reduce stress concentrators) unless recruitment maneuvers with sufficient PEEP were added to…”

Section: Optimizing the Mechanical Breathmentioning

confidence: 99%

See 3 more Smart Citations

Impact of mechanical ventilation on the pathophysiology of progressive acute lung injury

Nieman

Gatto

Habashi

2015

Journal of Applied Physiology

View full text Add to dashboard Cite

Nieman GF, Gatto LA, Habashi NM. Impact of mechanical ventilation on the pathophysiology of progressive acute lung injury. J Appl Physiol 119: 1245-1261. First published October 15, 2015 doi:10.1152/japplphysiol.00659.2015The earliest description of what is now known as the acute respiratory distress syndrome (ARDS) was a highly lethal double pneumonia. Ashbaugh and colleagues (Ashbaugh DG, Bigelow DB, Petty TL, Levine BE Lancet 2: 319-323, 1967) correctly identified the disease as ARDS in 1967. Their initial study showing the positive effect of mechanical ventilation with positive end-expiratory pressure (PEEP) on ARDS mortality was dampened when it was discovered that improperly used mechanical ventilation can cause a secondary ventilator-induced lung injury (VILI), thereby greatly exacerbating ARDS mortality. This Synthesis Report will review the pathophysiology of ARDS and VILI from a mechanical stress-strain perspective. Although inflammation is also an important component of VILI pathology, it is secondary to the mechanical damage caused by excessive strain. The mechanical breath will be deconstructed to show that multiple parameters that comprise the breath-airway pressure, flows, volumes, and the duration during which they are applied to each breath-are critical to lung injury and protection. Specifically, the mechanisms by which a properly set mechanical breath can reduce the development of excessive fluid flux and pulmonary edema, which are a hallmark of ARDS pathology, are reviewed. Using our knowledge of how multiple parameters in the mechanical breath affect lung physiology, the optimal combination of pressures, volumes, flows, and durations that should offer maximum lung protection are postulated. acute lung injury; lung; pathophysiology ventilator; VILI THE POLIO EPIDEMIC OF 1916 inspired many treatment attempts including vitamin C therapy, hydrotherapy, and electrotherapy, but no effective therapy was found until Philip Drinker's group invented negative pressure mechanical ventilation-the iron lung. Their landmark paper, "The use of a new apparatus for the prolonged administration of artificial respiration: I. A fatal case of poliomyelitis," published in 1929, demonstrated the effective clinical use of this device (Fig. 1) (38). The concept of conversion from negative to positive pressure ventilation was based on technical advances that were made during World War II to deliver pressurized oxygen to high-altitude fighter and bomber pilots. Concomitant with these technologic advances in mechanical ventilation was the realization that what was originally thought to be a universally fatal form of double pneumonia was indeed a unique clinical entity that we now call the acute respiratory distress syndrome (ARDS). In a 1967 seminal paper published in The Lancet, Ashbaugh et al. (10) first identified and described ARDS as a collection of pathologic abnormalities that can be caused by many unrelated insults such as sepsis, hemorrhagic shock, pneumonia, and trauma to name a few. The disease and the ventil...

show abstract

Section: Synthesis Reviewsupporting

confidence: 65%

Section: Mechanical Ventilation and The Incidence Of Ardsmentioning

confidence: 99%

Section: Physiological Evidence That the Mechanical Breath Can Block mentioning

confidence: 99%

Section: Optimizing the Mechanical Breathmentioning

confidence: 99%

See 2 more Smart Citations

Impact of mechanical ventilation on the pathophysiology of progressive acute lung injury

Nieman

Gatto

Habashi

2015

Journal of Applied Physiology

View full text Add to dashboard Cite

show abstract

“…[20][21][22][23][24] Multiple studies in patients in the ICU have shown that preemptive protective MV can reduce ARDS incidence. Th is has been shown with conventional MV (CMV) using a combination of LV t , positive endexpiratory pressure (PEEP), and recruitment maneuvers (RMs), 22 including a preemptive randomized clinical trial demonstrating that ARDS incidence can be reduced in high-risk patients in the ICU.…”

Section: Patients In the Icumentioning

confidence: 99%

RETRACTED: Mechanical Ventilation as a Therapeutic Tool to Reduce ARDS Incidence

Nieman

Gatto

Bates

et al. 2015

Chest

View full text Add to dashboard Cite

Intraoperative use of low volume ventilation to decrease postoperative mortality, mechanical ventilation, lengths of stay and lung injury in adults without acute lung injury

Guay

Ochroch

Kopp

2018

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

We found moderate-quality evidence that low tidal volumes (defined as less than 10 mL/kg) decreases pneumonia and the need for postoperative ventilatory support (invasive and non-invasive). We found no difference in the risk of barotrauma (pneumothorax), but the number of participants included does not allow us to make definitive statement on this. The four studies in 'Studies awaiting classification' may alter the conclusions of the review once assessed.

show abstract

Effect of lung-protective ventilation with lower tidal volumes on clinical outcomes among patients undergoing surgery: a meta-analysis of randomized controlled trials

Cited by 53 publications

References 46 publications

Impact of mechanical ventilation on the pathophysiology of progressive acute lung injury

Impact of mechanical ventilation on the pathophysiology of progressive acute lung injury

RETRACTED: Mechanical Ventilation as a Therapeutic Tool to Reduce ARDS Incidence

Intraoperative use of low volume ventilation to decrease postoperative mortality, mechanical ventilation, lengths of stay and lung injury in adults without acute lung injury

Contact Info

Product

Resources

About