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Vol. 46. Issue 11.
Pages 609-618 (November 2022)
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Vol. 46. Issue 11.
Pages 609-618 (November 2022)
Original article
Intermediate tidal volume is an acceptable option for ventilated patients with acute respiratory distress syndrome
El volumen tidal intermedio es una opción aceptable para pacientes ventilados con síndrome de dificultad respiratoria aguda
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S.-H. Wua,b,
Corresponding author
126366@cch.org.tw

Corresponding author.
, C.-T. Korc,d, C.-Y. Lie, Y.-C. Hsiaoa
a Division of Critical Care Internal Medicine, Department of Emergency Medicine and Critical Care, Changhua Christian Hospital, Changhua, Taiwan
b Medical College, National Chung-Hsing University, Taichung, Taiwan
c Big Data Center, Changhua Christian Hospital, Changhua, Taiwan
d Graduate Institute of Statistics and Information Science, National Changhua University of Education, Changhua, Taiwan
e Section of Respiratory Therapy, Department of Emergency Medicine and Critical Care, Changhua Christian Hospital, Changhua, Taiwan
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Abstract
Objective

Evidence only proves low surpasses high tidal volume (VT) for acute respiratory distress syndrome (ARDS). Intermediate VT is a common setting for ARDS patients and has been demonstrated as effective as low VT in non-ARDS patients. The effectiveness of intermediate VT in ARDS has not been studied and is the objective of this study.

Design

A retrospective cohort study.

Setting

Five ICUs with their totally 130 beds in Taiwan.

Patients or participants

ARDS patients under invasive ventilation.

Interventions

No.

Main variables of interest

28-D mortality.

Result

Totally 382 patients, with 6958 ventilator settings eligible for lung protection, were classified into low (mean VT=6.7ml/kg), intermediate (mean VT=8.9ml/kg) and high (mean VT=11.2ml/kg) VT groups. With similar baseline ARDS and ICU severities, intermediate and low VT groups did not differ in 28-D mortality (47% vs. 63%, P=0.06) or other outcomes such as 90-D mortality, ventilator-free days, ventilator-dependence rate. Multivariate analysis revealed high VT was independently associated with 28-D and 90-D mortality, but intermediate VT was not significantly associated with 28-D mortality (HR 1.34, CI 0.92–1.97, P=0.13) or 90-D mortality. When the intermediate and low VT groups were matched in propensity scores (n=66 for each group), their outcomes were also not significantly different.

Conclusion

Intermediate VT, with its outcomes similar to small VT, is an acceptable option for ventilated ARDS patients. This conclusion needs verification through clinical trials.

Keywords:
Acute respiratory distress syndrome
Mechanical ventilation
Tidal volume
Ventilator-induced lung injury
Resumen
Objetivo

La evidencia solo demuestra que el volumen tidal (VT) bajo supera al alto para el síndrome de dificultad respiratoria aguda (ARDS). La VT intermedia es un escenario común para los pacientes con ARDS y se ha demostrado que es tan eficaz como la VT baja en pacientes sin ARDS. No se ha estudiado la eficacia de la VT intermedia en el ARDS y es el objetivo de este estudio.

Diseño

Un estudio de cohorte retrospectivo.

Ámbito

Cinco UCI con un total de 130 camas en Taiwán.

Pacientes o participantes

Pacientes con ARDS bajo ventilación invasiva.

Intervenciones

No.

Variables de interés principales

Mortalidad 28-D.

Resultado

Un total de 382 pacientes, con 6958 configuraciones de ventilador elegibles para protección pulmonar, se clasificaron en bajo (VT medio=6,7ml/kg), intermedio (VT medio=8,9ml/kg) y alto (VT medio=11,2ml/kg). Grupos de VT. Con un ARDS inicial similar y una gravedad en la UCI, los grupos de VT intermedia y baja no difirieron en la mortalidad 28-D (47% vs. 63%, p=0,06) u otros resultados como mortalidad 90-D, días sin ventilador, dependencia del ventilador índice. El análisis multivariado reveló que la VT alta se asoció de forma independiente con la mortalidad 28-D y 90-D, pero la VT intermedia no se asoció significativamente con la mortalidad 28-D (HR 1,34, IC 0,92-1,97, p=0,13) o la mortalidad 90-D. Cuando los grupos de VT intermedia y baja se emparejaron en puntajes de propensión (n=66 para cada grupo), sus resultados tampoco fueron significativamente diferentes.

Conclusión

La VT intermedia, con resultados similares a la VT pequeña, es una opción aceptable para pacientes con ARDS ventilados. Esta conclusión necesita verificación a través de ensayos clínicos.

Palabras clave:
Síndrome de dificultad respiratoria aguda
Ventilación mecánica
Volumen corriente
Lesión pulmonar inducida por ventilación

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