Traditional approaches to mechanical ventilation use tidal volumes of 10 to 15 ml per kilogram of body weight. 2-4 Although substantial progress has been made in elucidating the mechanisms of acute lung injury, 5 there has been little progress in developing effective treatments. The mortality rate from acute lung injury and the acute respiratory distress syndrome 1 is approximately 40 to 50 percent. In patients with acute lung injury and the acute respiratory distress syndrome, mechanical ventilation with a lower tidal volume than is traditionally used results in decreased mortality and increases the number of days without ventilator use. The mean tidal volumes on days 1 to 3 were 6.2☐.8 and 11.8☐.8 ml per kilogram of predicted body weight (P<0.001), respectively, and the mean plateau pressures were 25☖ and 33☘ cm of water (P<0.001), respectively. 39.8 percent, P=0.007), and the number of days without ventilator use during the first 28 days after randomization was greater in this group (mean, 12☑1 vs. The trial was stopped after the enrollment of 861 patients because mortality was lower in the group treated with lower tidal volumes than in the group treated with traditional tidal volumes (31.0 percent vs. The second primary outcome was the number of days without ventilator use from day 1 to day 28. The first primary outcome was death before a patient was discharged home and was breathing without assistance. The trial compared traditional ventilation treatment, which involved an initial tidal volume of 12 ml per kilogram of predicted body weight and an airway pressure measured after a 0.5-second pause at the end of inspiration (plateau pressure) of 50 cm of water or less, with ventilation with a lower tidal volume, which involved an initial tidal volume of 6 ml per kilogram of predicted body weight and a plateau pressure of 30 cm of water or less. Patients with acute lung injury and the acute respiratory distress syndrome were enrolled in a multicenter, randomized trial. We therefore conducted a trial to determine whether ventilation with lower tidal volumes would improve the clinical outcomes in these patients. Traditional approaches to mechanical ventilation use tidal volumes of 10 to 15 ml per kilogram of body weight and may cause stretch-induced lung injury in patients with acute lung injury and the acute respiratory distress syndrome. The most trusted, influential source of new medical knowledge and clinical best practices in the world. Information and tools for librarians about site license offerings. Valuable tools for building a rewarding career in health care. The authorized source of trusted medical research and education for the Chinese-language medical community. The most advanced way to teach, practice, and assess clinical reasoning skills. Information, resources, and support needed to approach rotations - and life as a resident. The most effective and engaging way for clinicians to learn, improve their practice, and prepare for board exams. NEW! Peer-reviewed journal featuring in-depth articles to accelerate the transformation of health care delivery.Ĭoncise summaries and expert physician commentary that busy clinicians need to enhance patient care. NEW! A digital journal for innovative original research and fresh, bold ideas in clinical trial design and clinical decision-making.
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