Prospective, randomized, controlled clinical trial comparing traditional versus reduced tidal volume ventilation in acute respiratory distress syndrome patients
Prospective, randomized, controlled clinical trial comparing traditional versus reduced tidal volume ventilation in acute respiratory distress syndrome patients
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DOI：
10.1097/00003246-199908000-00015
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发表时间：
1999-08-01
影响因子：
8.8
通讯作者：
Piantadosi, S
中科院分区：
文献类型：
--
作者：
Brower, RG;Shanholtz, CB;Piantadosi, S
目的：评估旨在减少急性呼吸窘迫综合征中牵拉性肺损伤的机械通气策略的安全性和潜在功效。设计：前瞻性、随机、对照临床试验。地点：四家教学医院的八个重症监护病房。患者：52 名急性呼吸窘迫综合征患者。干预措施：传统潮气量患者：潮气量 10-12 mL/kg 理想体重，如果吸气平台压 >55 cm H2O (7.3千帕）。小潮气量患者：潮气量 5-8 mL/kg 理想体重，保持平台压 < 30 cm H2O (4.0 kPa)。 测量和主要结果：传统和小潮气量患者前 5 天的平均潮气量分别为 10.2 和 7.3 mL/kg (p < .001)，平均平台压 = 30.6 和 24.9 cmH(2)O (3.3 kPa)，分别 (p < .001)。呼气末正压或 Flo(2)、液体摄入量/排出量、升压药、镇静剂或神经肌肉阻滞剂的需求、实现无辅助呼吸的患者百分比、呼吸机天数或死亡率没有显着差异。结论：本研究中使用的减少潮气量策略是安全的。未能观察到小潮气量通气治疗对重要临床结果变量的有益影响可能是因为：a) 样本量太小，无法辨别小的治疗效果； b) 潮气量和平台压的差异不大；或 c) 减少潮气量通气是没有好处的。
Objective: To assess the safety and potential efficacy of a mechanical ventilation strategy designed to reduce stretch-induced lung injury in acute respiratory distress syndrome.Design: Prospective, randomized, controlled clinical trial.Setting: Eight intensive care units in four teaching hospitals.Patients: Fifty-two patients with acute respiratory distress syndrome.Interventions: Traditional tidal volume patients: tidal volume 10-12 mL/kg ideal body weight, reduced if inspiratory plateau pressure was >55 cm H2O (7.3 kPa). Small tidal volume patients: tidal volume 5-8 mL/kg ideal body weight, to keep plateau pressure < 30 cm H2O (4.0 kPa).Measurements and Main Results: Mean tidal volumes during the first 5 days in traditional and small tidal volume patients were 10.2 and 7.3 mL/kg, respectively (p < .001), with mean plateau pressure = 30.6 and 24.9 cmH(2)O (3.3 kPa), respectively (p < .001). There were no significant differences in requirements for positive end-expiratory pressure or Flo(2), fluid intakes/outputs, requirements for vasopressors, sedatives, or neuromuscular blocking agents, percentage of patients that achieved unassisted breathing, ventilator days, or mortality.Conclusions: The reduced tidal volume strategy used in this study was safe. Failure to observe beneficial effects of small tidal volume ventilation treatment in important clinical outcome variables may have occurred because a) the sample size was too small to discern small treatment effects; b) the differences in tidal volumes and plateau pressures were modest; or c) reduced tidal volume ventilation is not beneficial.