title: Ventilation with lower tidal volumes for critically ill patients without the acute respiratory distress syndrome: a systematic translational review and meta-analysis.
abstract: OBJECTIVE
  There is convincing evidence for benefit from lung-protective mechanical ventilation with lower tidal volumes in patients with the acute respiratory distress syndrome (ARDS). It is uncertain whether this strategy benefits critically ill patients without ARDS as well. This manuscript systematically reviews recent preclinical studies of ventilation in animals with uninjured lungs, and clinical trials of ventilation in ICU patients without ARDS on the association between tidal volume size and pulmonary complications and outcome.
  
  
  RESULTS
  Successive preclinical studies almost without exception show that ventilation with lower tidal volumes reduces the injurious effects of ventilation in animals with uninjured lungs. This finding is in line with results from recent trials in ICU patients without ARDS, demonstrating that ventilation with lower tidal volumes has a strong potential to prevent development of pulmonary complications and maybe even to improve survival. However, evidence mostly comes from nonrandomized clinical trials, and concerns are expressed regarding unselected use of lower tidal volumes in the ICU, that is, in all ventilated critically ill patients, since this strategy could also increase needs for sedation and/or neuromuscular blockade, and maybe even cause respiratory muscle fatigue. These all then could in fact worsen outcome, possibly counteracting the beneficial effects of ventilation with lower tidal volumes.
  
  
  CONCLUSIONS
  Ventilation with lower tidal volumes protects against pulmonary complications, but well-powered randomized controlled trials are urgently needed to determine whether this ventilation strategy truly benefits all ventilated ICU patients without ARDS.
authors.affiliation: aMedical Intensive Care Unit, ABC Medical School (FMABC), Santo André bDepartment of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil cDepartment of Intensive Care dLaboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Ary
authors.initials: A
authors.lastname: Serpa Neto
authors.forename: Liselotte
authors.initials: L
authors.lastname: Nagtzaam
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Schultz
mesh_terms: D000328:Adult; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D006801:Humans; D007249:Inflammation; D007902:Length of Stay; D008297:Male; D012121:Respiration, Artificial / Q000379:methods; D013990:Tidal Volume; D016896:Treatment Outcome; D055397:Ventilator-Induced Lung Injury / Q000517:prevention & control*