Even if you don’t have ARDS or risk factors for ARDS, a lung protective ventilation strategy seems to be good for your patients according to a recent meta-analysis published in JAMA.
I use it all the time, and I hope most of us do. So this might not be big news, but it’s always good to get a meta-confirmation that lung protective ventilation is a good thing – even for your standard, elective patient. In this meta-analysis looking at lung protective vs standard old school protocol ventilation (usually Tidal volumes between 4-6ml/kg IBW vs 8-10ml/kg IBW), the lung protective strategy showed an over-all lower mortality, lower incidence of pulmonary complications and shorter hospital stays. Good for us, good for the hospital and good for the patient.
Hi !
I’ve started learning anesthesia and critical care with the publication of the major article from the ARDS network. So like you i tend to use lower Vt
But, i think there a gap between critical care setting and anesthesia setting. There’s really a big mix in this study. And sometimes 6 ml/kg is really low and you need a really high frequency to achieve a good EtCO2. This may interfere with the surgical work. Especially during mixed abdominal and thoracic interventions like oesophagectomy.
So i keep in mind to an “average Vt” (more around 7 ml/kg) and to FOCUS on the Pplat pressure with the same rationale as in the ExPress trial
bye
I agree with you, low tidal volume ventilation is no more a dogma than anything else in medicine. One thing I like about anaesthesia and critical care is that treatment needs to be individualised and research on big cohorts can never be more than a guide.
I use low tidal volume more as a guide for patients/operations that are not at big risk of ARDS. But I found this article a good reminder that low tidal volumes seem a good idea if it can easily be achieved.
Thanks for your comments, they’re much appreciated!