Mechanical ventilation at lower level among patients without lung injury linked with better outcomes

October 23, 2012 in Diseases, Conditions, Syndromes

Among patients without acute respiratory distress syndrome, protective mechanical ventilation with use of lower tidal volumes (the volume of air inhaled and exhaled during each breath) was associated with better outcomes including less lung injury, lower mortality, fewer pulmonary infections and a shorter hospital length of stay, according to a meta-analysis of previous studies, reported in the October 24/31 issue of JAMA.

"Mechanical ventilation is a life-saving strategy in patients with acute respiratory failure. However, unequivocal evidence suggests that mechanical ventilation has the potential to aggravate and precipitate lung injury. In acute (ARDS), and in a milder form of ARDS formerly known as (ALI), mechanical ventilation can cause ventilator-associated lung injury," according to background information in the article. "Lung-protective mechanical ventilation with the use of lower tidal volumes has been found to improve outcomes of patients with ARDS. It has been suggested that use of lower tidal volumes also benefits patients who do not have ARDS."

Ary Serpa Neto, M.D., M.Sc., of ABC Medical School, Santo Andre, Sao Paulo, Brazil and colleagues conducted a meta-analysis to determine whether conventional (higher) or protective (lower) tidal volumes would be associated with lung injury, mortality, and pulmonary infection in patients without lung injury at the onset of mechanical ventilation. After a search of the medical literature, the researchers identified 20 articles (2,822 participants) that met criteria for inclusion in the study.

Analysis of the data indicated a 67 percent decreased risk of lung injury development and 36 percent decrease in the risk of death in patients receiving ventilation with lower tidal volumes. The results of lung injury development were similar when stratified by the type of study (randomized vs. nonrandomized) and were significant only in for pulmonary infection and only in nonrandomized trials for mortality. Analysis also showed, in protective ventilation groups, a lower incidence of and lower average hospital length of stay (approximately 7 vs. 9 days, respectively).

"In conclusion, our meta-analysis suggests that among patients without lung injury, protective ventilation with use of lower tidal volumes at onset of mechanical ventilation may be associated with better clinical outcomes. We believe that clinical trials are needed to compare higher vs. lower tidal volumes in a heterogeneous group of patients receiving for longer periods," the authors write.

More information: JAMA. 2012;308[16]:1651-1659

Journal reference: Journal of the American Medical Association search and more info website

Provided by JAMA and Archives Journals search and more info website

not rated yet  

Rank not rated yet
Relevant PhysicsForums posts

More news stories

Researchers find genetic risk factor for pulmonary fibrosis

A paper recently published in the New England Journal of Medicine and co-written by physicians and scientists at the University of Colorado School of Medicine finds that an important genetic risk factor for pulmonary fibros ...

Diseases, Conditions, Syndromes created 13 hours ago | popularity not rated yet | comments 0

Biomarkers discovered for inflammatory bowel disease

Using the Department of Defense Serum Repository (DoDSR), University of Cincinnati (UC) researchers have identified a number of biomarkers for inflammatory bowel disease (IBD), which could help with earlier diagnosis and ...

Diseases, Conditions, Syndromes created 13 hours ago | popularity 5 / 5 (1) | comments 0

CDC says high number of public pools contain microbes

(HealthDay)—Three-quarters of public schools in the metro Atlanta area contain microbes, including bacteria indicating the presence of fecal matter, according to research published in the May 17 issue of ...

Diseases, Conditions, Syndromes created 14 hours ago | popularity not rated yet | comments 0

Study examines outbreak of spinal infections in Michigan

(HealthDay)—Factors such as increased case finding may explain why Michigan had half of the total spinal infections associated with contaminated methylprednisolone acetate in the recent fungal meningitis ...

Diseases, Conditions, Syndromes created 14 hours ago | popularity not rated yet | comments 0

World not ready for mass flu outbreak, WHO says

The world is unprepared for a massive virus outbreak, the deputy chief of the World Health Organization warned Tuesday, amid fears that H7N9 bird flu striking China could morph into a form that spreads easily among people.

Diseases, Conditions, Syndromes created 15 hours ago | popularity not rated yet | comments 0


Portland, Ore., rejecting water fluoridation

(AP)—The mayor of Portland, Ore., has conceded defeat in an effort to add fluoride to the city's drinking water.

Study says empathy plays a key role in moral judgments

Is it permissible to harm one to save many? Those who tend to say "yes" when faced with this classic dilemma are likely to be deficient in a specific kind of empathy, according to a report published in the scientific journal ...

Phthalates: Study links chemicals widely found in plastics, processed food to elevated blood pressure in children, teens

Plastic additives known as phthalates (pronounced THAL-ates) are odorless, colorless and just about everywhere: They turn up in flooring, plastic cups, beach balls, plastic wrap, intravenous tubing and—according to the ...

If you can remember it, you can remember it wrong

(Medical Xpress)—Native peoples in regions where cameras are uncommon sometimes react with caution when their picture is taken. The fear that something must have been stolen from them to create the photo ...

B vitamins could delay dementia

(Medical Xpress)—Despite spending billions of dollars on research and development, drug companies have been unable to come up with effective treatments for dementia and Alzheimer's Disease (AD). Now, A. ...

Insight into the dazzling impact of insulin in cells

Australian scientists have charted the path of insulin action in cells in precise detail like never before. This provides a comprehensive blueprint for understanding what goes wrong in diabetes.