Prospective, randomized, controlled clinical trial comparing traditional versus reduced tidal volume ventilation in acute respiratory distress syndrome patients

Brower, Roy G.; Shanholtz, Carl; Fessler, H; Shade, David M.; White, Peter; Wiener, Charles; Teeter, John G.; Dodd‐o, Jeffrey M.; Almog, Yaniv; Piantadosi, Steven

doi:10.1097/00003246-199908000-00015

Cited by 493 publications

(256 citation statements)

References 31 publications

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“…As a result of the systematic review, only six 2013 Cochrane Review202‐adopted RCTs191, 203, 204, 205, 206, 207 involving the use of lung protective ventilation methods focusing primarily on low tidal volume in adult ARDS patients were identified. Mortality statistics were reported in all six studies ( n = 1,305), and while there was a difference in the follow‐up period, this period tended to be shorter in the low tidal volume group (risk ratio: 0.84, 95% confidence interval [CI]: 0.67–1.07).…”

Section: Cq10: Management Of the Mechanically Ventilated Patientmentioning

confidence: 99%

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The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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Background and PurposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

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Section: Cq10: Management Of the Mechanically Ventilated Patientmentioning

confidence: 99%

“…As a result of the systematic review, four RCTs (1,132 patients)191, 204, 205, 207 were identified. Prolonged VFD (2.5 days on average, 95% CI: 0.5–4.45) was confirmed by setting plateau pressure to ≤30 cmH 2 O for 5–7 days after the initiation of mechanical ventilation.…”

Section: Cq10: Management Of the Mechanically Ventilated Patientmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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“…Ventilation with low tidal volumes in patients with ARDS/ALI is now the standard of care. 1,2,[23][24][25][26] However, patients with ALI represent a minority of ventilated ICU patients and an even smaller fraction of those ventilated in the operating room. It has been suggested that other patients may also benefit from low tidal volumes.…”

Section: Discussionmentioning

confidence: 99%

Influence of Low Tidal Volume Ventilation on Time to Extubation in Cardiac Surgical Patients

Sundar¹,

Novack²,

Jervis³

et al. 2011

Survey of Anesthesiology

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Background-Low tidal volumes have been associated with improved outcomes in patients with established acute lung injury. The role of low tidal volume ventilation in patients without lung injury is still unresolved. We hypothesized that such a strategy in patients undergoing elective surgery would reduce ventilator-associated lung injury and that this improvement would lead to a shortened time to extubation

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“…There is convincing evidence that the use of high tidal volumes (12 mL/kg of predicted body weight) results in increased mortality as compared with the use of low tidal volumes (6 mL/kg of predicted body weight) [30]. Unfortunately, the tidal volumes tested in several randomized trials were normalized by the body weight (actual or ideal) [30][31][32][33][34]. This standardization was introduced, although not explicitly stated, as a surrogate for standardization of the lung size.…”

Section: Assessment Of Lung Protection and Setting The Tidal Volumementioning

confidence: 99%

The Role of CT-scan Studies for the Diagnosis and Therapy of Acute Respiratory Distress Syndrome

Gattinoni

Caironi

Valenza

et al. 2006

Clinics in Chest Medicine

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The radiologic assessment of lung infiltrates by conventional anterior-posterior chest radiographs has been embedded in the concept of acute respiratory distress syndrome (ARDS) since its original description by Ashbaugh and colleagues [1]. In fact, the presence of bilateral lung infiltrates as detected by chest radiograph, in association with ''refractory'' hypoxemia and impaired mechanics of the respiratory system (stiff lung), was one of the mandatory criteria for ARDS diagnosis. In the mid-1980s, however, the first reports describing ARDS by using CT scanning changed the view of the syndrome [2][3][4]: the ARDS lung appeared to be affected by the disease process nonhomogeneously, with the CT densities distributed mainly in the dependent lung regions. The quantitative analysis of CT scanning gave new insights concerning the pathophysiology of the syndrome and provided a firm rationale for modifying the mechanical ventilation in use at that time [5][6][7]. This article discusses in some detail what the authors believe is or should be the role of the CT scanning in the diagnosis and therapy of ARDS. Quantitative analysis of CT scanningBecause the authors believe that the quantitative analysis of CT scanning is of paramount importance for ARDS diagnosis and for a rational setting of mechanical ventilation, a brief description of the technique and its limits is necessary. (A more detailed description of the quantitative analysis may be found elsewhere [7,8]). Physical principles of CT scanningThe digital image produced by the CT scan is based on the measure of the attenuation coefficient (m) (ie, the reduction of the radiation intensity upon passage through matter). Traversing from one side of the patient to the other, the X-ray beam is attenuated by all the voxels (volume elements of the tissue) through which passes. The intensity of the emerging X-ray is described by the Lambert law of absorption, that is,where I is the intensity of the emerging X-ray beam, and I 0 is the intensity of the X-ray beam at the source. By measuring the intensity I and I 0 , the CT calculates the integral over the function m of the attenuation coefficient along the X-ray beam. Then, through a different mathematical algorithm (usually filtered back projection), a given attenuation number m is assigned to each voxel (m voxel ). This attenuation number primarily represents the density of the voxel (ie, the ratio of mass to the volume) and is expressed as the CT number [9], which relates to the density of the water (m water ):CT ¼ 1000 Â m voxel À m water m waterConventionally a CT number equal to zero Hounsfield units (HU) indicates that density equals

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Prospective, randomized, controlled clinical trial comparing traditional versus reduced tidal volume ventilation in acute respiratory distress syndrome patients

Cited by 493 publications

References 31 publications

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Influence of Low Tidal Volume Ventilation on Time to Extubation in Cardiac Surgical Patients

The Role of CT-scan Studies for the Diagnosis and Therapy of Acute Respiratory Distress Syndrome

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