Key result
Protective mechanical ventilation significantly reduced the risk of developing acute lung injury (RR 0.27) compared to conventional ventilation in patients without pre-existing lung injury.
Why the study?
Does protective mechanical ventilation reduce lung injury in patients without ARDS at the onset of mechanical ventilation?
Meta-Analysis (n=1,362)
Does protective mechanical ventilation reduce lung injury in patients without ARDS at the onset of mechanical ventilation?
Relative Risk: 0.27 (95% CI 0.12–0.59)
In patients without pre-existing lung injury, a protective mechanical ventilation strategy using lower tidal volumes significantly reduces the risk of developing acute lung injury and pulmonary infections compared to conventional ventilation.
Supports protective ventilation to prevent acute lung injury in at-risk patients; extends evidence to perioperative and ICU settings without pre-existing injury.
Acute respiratory distress syndrome (ARDS) is one of the main causes of mortality in critically ill patients. Injured lungs can be protected by optimum mechanical ventilator settings, using low tidal volume (VT) values and higher positive-end expiratory pressure (PEEP); the benefits of this protective strategy on outcomes have been confirmed in several prospective randomized controlled trials (RCTs). The question is whether healthy lungs need specific protective ventilatory settings when they are at risk of injury. We performed a systematic review of the scientific literature and a meta-analysis regarding the rationale of applying protective ventilatory strategies in patients at risk of ARDS in the perioperative period and in the intensive care unit (ICU).
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Sutherasan et al. (2014) conducted a meta-analysis in Patients without ARDS or ALI requiring mechanical ventilation (n=1,362). Protective mechanical ventilation vs. Conventional ventilation (average tidal volume 10.7 ml/kg) was evaluated on Development of lung injury (RR 0.27, 95% CI 0.12-0.59). Protective mechanical ventilation significantly reduced the risk of developing acute lung injury (RR 0.27) compared to conventional ventilation in patients without pre-existing lung injury.
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