title: Mechanical ventilation in acute lung injury and ARDS. Tidal volume reduction.
abstract: Traditional mechanical ventilation practices used generous tidal volumes in patients with acute lung injury and acute respiratory distress syndrome (ALI/ARDS). This approach may have caused overdistention of aerated lung units, thus exacerbating lung injury in some patients. Several recent clinical trials of traditional versus lower tidal volume strategies in ALI/ARDS yielded disparate results. In the largest study, the lower tidal volume approach was associated with lower mortality and more ventilator-free days. This article reviews the rationale for tidal volume reduction in ALI/ARDS and the differences between the studies. Several different interpretations of the recent clinical trial results are addressed.
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Roy G
authors.initials: RG
authors.lastname: Brower
mesh_terms: D000328:Adult; D000818:Animals; D006801:Humans; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy*; D013990:Tidal Volume