B T Thompson, D Hayden, M A Matthay, R Brower, and P E Parsons.
Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. tthompson1@partners.org
Chest. 2001 Nov 1;120(5):1622-7.
Study ObjectivesTo examine clinicians' approaches to mechanical ventilation in patients with acute lung injury (ALI; PaO(2)/fraction of inspired oxygen [FIO(2)] DesignRetrospective analysis of baseline data from prospective randomized trials conducted by the National Institutes of Health ARDS Network between 1996 and 1999.SettingTen clinical centers comprising 24 hospitals and 74 medical and surgical ICUs of the ARDS Network.Measurements And ResultsThe most common mode of mechanical ventilation in both groups was volume-assist control (56%). Synchronized intermittent mandatory ventilation (SIMV) or SIMV with pressure support was used more often in patients with PaO(2)/FIO(2) of 201 to 300 than in patients with ARDS. The use of pressure-control ventilation was uncommon (10% overall), as was the use of permissive hypercapnia (6% of patients with ARDS and 3% of patients with PaO(2)/FIO(2) of 201 to 300). The mean +/- SD tidal volume was 10.3 +/- 2 mL/kg of predicted body weight or 8.6 +/- 2 mL/kg of measured weight for patients with ARDS, and was not significantly different for patients with PaO(2)/FIO(2) of 201 to 300. Plateau pressures (Pplats) were lower in the PaO(2)/FIO(2) of 201 to 300 group (27 +/- 7 vs 31 +/- 8 for the ARDS group; p = 0.0003) and were > 35 cm H(2)O in 26% of patients. Seventy-eight percent of patients with ARDS received ConclusionsPhysicians in ARDS Network centers caring for patients early in the course of ALI/ARDS used volume-targeted ventilation and selected tidal volumes that resulted in Pplats generally < 35 cm H(2)O. The average tidal volume was similar for patients with ARDS vs those with milder oxygenation deficits.