title: Influence of low tidal volume ventilation on time to extubation in cardiac surgical patients.
abstract: BACKGROUND
  Low tidal volumes have been associated with improved outcomes in patients with established acute lung injury. The role of low tidal volume ventilation in patients without lung injury is still unresolved. We hypothesized that such a strategy in patients undergoing elective surgery would reduce ventilator-associated lung injury and that this improvement would lead to a shortened time to extubation
  
  
  METHODS
  A single-center randomized controlled trial was undertaken in 149 patients undergoing elective cardiac surgery. Ventilation with 6 versus 10 ml/kg tidal volume was compared. Ventilator settings were applied immediately after anesthesia induction and continued throughout surgery and the subsequent intensive care unit stay. The primary endpoint of the study was time to extubation. Secondary endpoints included the proportion of patients extubated at 6 h and indices of lung mechanics and gas exchange as well as patient clinical outcomes.
  
  
  RESULTS
  Median ventilation time was not significantly different in the low tidal volume group; a median (interquartile range) of 450 (264-1,044) min was achieved compared with 643 (417-1,032) min in the control group (P = 0.10). However, a higher proportion of patients in the low tidal volume group was free of any ventilation at 6 h: 37.3% compared with 20.3% in the control group (P = 0.02). In addition, fewer patients in the low tidal volume group required reintubation (1.3 vs. 9.5%; P = 0.03).
  
  
  CONCLUSIONS
  Although reduction of tidal volume in mechanically ventilated patients undergoing elective cardiac surgery did not significantly shorten time to extubation, several improvements were observed in secondary outcomes. When these data are combined with a lack of observed complications, a strategy of reduced tidal volume could still be beneficial in this patient population.
authors: Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
authors: Sugantha
authors: S
authors: Sundar
authors: Victor
authors: V
authors: Novack
authors: Karinne
authors: K
authors: Jervis
authors: S Patrick
authors: SP
authors: Bender
authors: Adam
authors: A
authors: Lerner
authors: Peter
authors: P
authors: Panzica
authors: Feroze
authors: F
authors: Mahmood
authors: Atul
authors: A
authors: Malhotra
authors: Daniel
authors: D
authors: Talmor
mesh_terms: D055371:Acute Lung Injury / Q000150:complications*; D000368:Aged; D000768:Anesthesia, General; D006348:Cardiac Surgical Procedures; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008170:Lung Compliance; D008297:Male; D011175:Positive-Pressure Respiration / Q000379:methods*; D012129:Respiratory Function Tests; D013990:Tidal Volume; D013997:Time Factors; D055397:Ventilator-Induced Lung Injury / Q000517:prevention & control