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.

Association Between Use of Lung-Protective Ventilation With Lower Tidal Volumes and Clinical Outcomes Among Patients Without Acute Respiratory Distress Syndrome: A Meta-analysis, JAMA, oct 2012.

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  1. nfkb says:

    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


  2. Thomas D says:

    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!


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