March 18, 2014Critical Care152 citationsOpen Access
Protective mechanical ventilation in the non-injured lung: review and meta-analysis
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.
Study Design
Type
Meta-Analysis (n=1,362)
Structured PICO
Does protective mechanical ventilation reduce lung injury in patients without ARDS at the onset of mechanical ventilation?
P
Population
1,362 surgical and critically ill patients without acute respiratory distress syndrome or acute lung injury at the onset of mechanical ventilation.
I
Intervention
Protective ventilation strategy (low tidal volume with or without high positive end-expiratory pressure [PEEP]), with an average tidal volume of 6.1 ml/kg.
C
Comparator
Standard/conventional ventilation strategy (high tidal volume with or without low PEEP), with an average tidal volume of 10.7 ml/kg.
O
Outcome
Development of lung injury in each study group.hard clinical
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.
Main Result
Relative Risk: 0.27 (95% CI 0.12–0.59)
Limitations
- Heterogeneity in the analysis of atelectasis and length of stay
Abstract
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).