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Intensive Care Medicine
Published in: Intensive Care Medicine 1/2013

01-01-2013 | Editorial

Lower tidal volumes for everyone: principle or prescription?

Author: John J. Marini

Published in: Intensive Care Medicine | Issue 1/2013

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Excerpt

As demonstrated by the persuasive essay by Lellouche and Lipes [1] appearing in this issue, an attractive argument can be made for using relatively low tidal volumes in all ventilated patients at risk of ARDS. It is hard to quibble with the intent or rationale—after all, in any given individual, tidal volume is achieved by driving pressure, a key component of the VILI equation. Moreover, no safe threshold for tidal volume has yet been identified in clinical trials of ALI/ARDS management [2], and because targeting lower tidal volumes seems to reduce the incidence of adverse outcomes [3, 4], ‘low’ tidal volumes should be applied to all ventilated patients potentially at risk. Sounds very reasonable—what is there not to like? …
Literature
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Hager DN, Krishnan JA, Hayden DL, Brower RG, ARDS Clinical Trials Network (2005) Tidal volume reduction in patients with acute lung injury when plateau pressures are not high. Am J Respir Crit Care Med 172:1241–1245PubMedCrossRef
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The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308CrossRef
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Gajic O, Frutos-Vivar F, Esteban A, Hubmayr RD, Anzueto A (2005) Ventilator settings as a risk factor for acute respiratory distress syndrome in mechanically ventilated patients. Intensive Care Med 31:922–926PubMedCrossRef
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Protti A, Cressoni M, Santini A, Langer T, Mietto C, Febres D, Chierichetti M, Coppola S, Conte G, Gatti S, Leopardi O, Masson S, Lombardi L, Lazzerini M, Rampoldi E, Cadringher P, Gattinoni L (2011) Lung stress and strain during mechanical ventilation: any safe threshold? Am J Respir Crit Care Med 183:1354–1362PubMedCrossRef
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Manning HL, Shea SA, Schwartzstein RM, Lansing RW, Brown R, Banzett RB (1992) Reduced tidal volume increases “air hunger” at fixed PCO2 in ventilated quadriplegics. Respir Physiol 90:19–30PubMedCrossRef
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Harty HR, Mummery CJ, Adams L, Banzett RB, Wright IG, Banner NR, Yacoub MH, Guz A (1996) Ventilatory relief of the sensation of the urge to breathe in humans: are pulmonary receptors important? J Physiol 490:805–815PubMed
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Housley E, Louzada N, Becklake MR (1970) To sigh or not to sigh? Am Rev Respir Dis 101:611–614PubMed
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Bendixen HH, Hedley-Whyte J, Laver MB (1963) Impaired oxygenation in surgical patients during general anesthesia with controlled ventilation. A concept of atelectasis. N Engl J Med 269:991–996PubMedCrossRef
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Jakob SM, Ruokonen E, Grounds RM, Sarapohja T, Garratt C, Pocock SJ, Bratty JR, Takala J, Dexmedetomidine for Long-Term Sedation Investigators (2012) Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JAMA 307:1151–1160PubMedCrossRef
Metadata
Title
Lower tidal volumes for everyone: principle or prescription?
Author
John J. Marini
Publication date
01-01-2013
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 1/2013
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-012-2754-2

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