Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome
Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome
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DOI：
10.1056/nejm199802053380602
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发表时间：
1998-02-05
影响因子：
158.5
通讯作者：
Carvalho, CRR
中科院分区：
文献类型：
--
作者：
Amato, MBP;Barbas, CSV;Carvalho, CRR
急性呼吸窘迫综合征患者在机械通气过程中，大量肺泡萎陷、周期性肺重新开放和过度扩张可能会使肺泡损伤持续存在。我们确定了一种旨在最大限度地减少这种肺损伤的治疗策略是否不仅可以减少急性呼吸窘迫综合征患者的肺部并发症，而且可以减少28天的死亡率。（包括之前描述的28例患者），所有患者均接受相同的血流动力学和一般支持，常规或保护性机械通气。常规通气基于维持可接受氧合的最低呼气末正压（PEEP）的策略，潮气量为12 ml/kg体重，动脉二氧化碳水平正常（35至38 mm Hg）。保护性通气包括呼气末压力高于静态压力-容量曲线上的下拐点，潮气量小于6 ml/kg，驱动压力低于PEEP值以上20 cm水柱，允许性高碳酸血症，以及优先使用压力限制通气模式。保护性通气组29例患者中有11例（38%）死亡，而常规通气组24例患者中有17例（71%）死亡（P
Background In patients with the acute respiratory distress syndrome, massive alveolar collapse and cyclic lung reopening and overdistention during mechanical ventilation may perpetuate alveolar injury. We determined whether a ventilatory strategy designed to minimize such lung injuries could reduce not only pulmonary complications but also mortality at 28 days in patients with the acute respiratory distress syndrome.Methods We randomly assigned 53 patients with early acute respiratory distress syndrome (including 28 described previously), all of whom were receiving identical hemodynamic and general support, to conventional or protective mechanical ventilation. Conventional ventilation was based on the strategy of maintaining the lowest positive end-expiratory pressure (PEEP) for acceptable oxygenation, with a tidal volume of 12 ml per kilogram of bodyweight and normal arterial carbon dioxide levels (35 to 38 mm Hg). Protective ventilation involved end-expiratory pressures above the lower inflection point on the static pressure-volume curve, a tidal volume of less than 6 ml per kilogram, driving pressures of less than 20 cm of water above the PEEP value, permissive hypercapnia, and preferential use of pressure-limited ventilatory modes.Results After 28 days, 11 of 29 patients (38 percent) in the protective-ventilation group had died, as compared with 17 of 24 (71 percent) in the conventional-ventilation group (P