Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial.
Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial.
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DOI：
10.1186/cc8230
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Schultz MJ
中科院分区：
文献类型：
--
作者：
Determann RM;Royakkers A;Wolthuis EK;Vlaar AP;Choi G;Paulus F;Hofstra JJ;de Graaff MJ;Korevaar JC;Schultz MJ
最近的队列研究已经确定，在无急性肺损伤（ALI）的机械通气患者中，大潮气量的使用是肺损伤发展的主要危险因素。我们比较了常规和低潮气量对机械通气开始时无ALI的危重患者肺部炎症和肺损伤发展的影响。我们进行了一项随机对照非盲性预防性试验，比较机械通气时潮汐量为10 ml和6 ml / kg预测体重的危重患者在机械通气开始时没有ALI。主要终点是机械通气期间支气管肺泡灌洗液和血浆中的细胞因子水平。次要终点是肺损伤的发展，由ALI的共识标准、机械通气持续时间和死亡率确定。150例患者（74例常规对照76例低潮气量）入组并进行分析。各组间灌洗液细胞因子水平基线无差异。血浆白细胞介素-6 （IL-6）水平在低潮容量组显著下降更强烈(从51(20至182)ng/ml降至11(5至20)ng/ml，从50(21至122)ng/ml降至21(20至77)ng/ml；P = 0.01))。由于安全原因，试验提前停止，因为与低潮气量组相比，常规潮气量组肺损伤发生率更高（13.5% vs 2.6%; P = 0.01）。单因素分析显示，基线肺损伤评分、随机分组、呼气末正压（PEEP）水平、输血制品数量、ALI危险因素的存在以及基线IL-6灌洗液水平与肺损伤的发生之间存在统计学关系。多因素分析显示，随机分组和PEEP水平是肺损伤发展的独立预测因素。常规潮气量的机械通气与持续的细胞因子产生有关，如血浆测量。我们的数据表明，在机械通气开始时，常规潮气量的机械通气有助于非ALI患者肺损伤的发展。ISRCTN82533884
Recent cohort studies have identified the use of large tidal volumes as a major risk factor for development of lung injury in mechanically ventilated patients without acute lung injury (ALI). We compared the effect of conventional with lower tidal volumes on pulmonary inflammation and development of lung injury in critically ill patients without ALI at the onset of mechanical ventilation. We performed a randomized controlled nonblinded preventive trial comparing mechanical ventilation with tidal volumes of 10 ml versus 6 ml per kilogram of predicted body weight in critically ill patients without ALI at the onset of mechanical ventilation. The primary end point was cytokine levels in bronchoalveolar lavage fluid and plasma during mechanical ventilation. The secondary end point was the development of lung injury, as determined by consensus criteria for ALI, duration of mechanical ventilation, and mortality. One hundred fifty patients (74 conventional versus 76 lower tidal volume) were enrolled and analyzed. No differences were observed in lavage fluid cytokine levels at baseline between the randomization groups. Plasma interleukin-6 (IL-6) levels decreased significantly more strongly in the lower-tidal-volume group ((from 51 (20 to 182) ng/ml to 11 (5 to 20) ng/ml versus 50 (21 to 122) ng/ml to 21 (20 to 77) ng/ml; P = 0.01)). The trial was stopped prematurely for safety reasons because the development of lung injury was higher in the conventional tidal-volume group as compared with the lower tidal-volume group (13.5% versus 2.6%; P = 0.01). Univariate analysis showed statistical relations between baseline lung-injury score, randomization group, level of positive end-expiratory pressure (PEEP), the number of transfused blood products, the presence of a risk factor for ALI, and baseline IL-6 lavage fluid levels and the development of lung injury. Multivariate analysis revealed the randomization group and the level of PEEP as independent predictors of the development of lung injury. Mechanical ventilation with conventional tidal volumes is associated with sustained cytokine production, as measured in plasma. Our data suggest that mechanical ventilation with conventional tidal volumes contributes to the development of lung injury in patients without ALI at the onset of mechanical ventilation. ISRCTN82533884
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影响因子：
158.5
作者：
Amato, MBP;Barbas, CSV;Carvalho, CRR
通讯作者：
Carvalho, CRR
影响因子：
8.8
作者：
Carney, David;DiRocco, Joseph;Nieman, Gary
通讯作者：
Nieman, Gary
DOI：
10.1164/rccm.200212-1449oc
发表时间：
2003-07-15
影响因子：
24.7
作者：
Fartoukh, M;Maître, B;Brun-Buisson, C
通讯作者：
Brun-Buisson, C
影响因子：
8.8
作者：
Levy, MM;Fink, MP;Ramsay, G
通讯作者：
Ramsay, G
影响因子：
38.9
作者：
Millo, JL;Schultz, MJ;Garrard, CS
通讯作者：
Garrard, CS