![]() ![]() The risk of bias for mortality was low when comparing LTV (4–8 ml/kg) versus HTV (> 8 ml/kg) (Fig. Vt 4–8 ml/kg PBW, driving pressure of 10 cm H 2OĬomparison of lower tidal volume versus higher tidal volume during ECMO PEEP: above 5 cm H 2O, and an FiO 2 ensuring arterial oxygen saturation 90% and PaO 2 of 70–100 mm HgĬomparison of any lower tidal volume versus any higher tidal volume PEEP: Computerized rules to maintain PaO 2 above 55 Vt 12 ml/kg PBW, Pplat < 50 cm H 2O PEEP: FiO 2 table VCV A/Cģ0-day (from KM), Death before a patient was discharged home ![]() Vt 6 (4–8)ml/kg PBW, Pplat < 30 cm H 2O PEEP: FiO 2 table VCV A/C ![]() PEEP: PEEP trial on 100% FiO 2 was performed using incremental (3–5 cm H 2O) levels from 3 to 15 cm H 2O PEEP: The PEEP was set at 2 to 3 cm H 2O higher than the pressure at Pflex No target, plateau airway pressure < 35 cm H 2O Vt 6 ml/kg IBW (titillated by computerized decision support) PEEP: titrated to PaO 2 (range 3–12 cm H 2O) PEEP: the range of 5 to 20 cm H 2O was adjusted in increments of 2.5 cm H 2O Vt 10–15 ml/kg IBW, peak pressure < 50 cm of water Vt 8 ml/kg IBW, peak pressure < 30 cm H 2O PEEP: increments of 5 cm H 2O (from 0 to 15) during pure oxygen breathing to determine the optimal level Vt 10–15 ml/kg PBW, peak airway pressure < 60 cm H 2O PEEP: stepwise algorithm for PEEP increments PEEP: preset at 2 cm of water above Pflex Therefore, this systematic review and meta-analysis aimed to evaluate the usefulness of the lower tidal volume ventilation strategy for patients with ARDS.Ĭomparison of lower tidal volume (6–8 ml/kg) versus higher tidal volume(> 8 ml/kg) To develop the Japanese ARDS guidelines 2021, an updated systematic review is warranted. Lower tidal volume ventilation (LTV) has potentially relevant benefits however, the certainty of evidence is imprecise. A recent systematic review of seven RCTs that included 1481 patients with ARDS demonstrated a trend towards lower risk of mortality, but the difference was insignificant (RR 0.87 95% CI 0.70–1.08) 17. The Cochrane Systematic Review of six trials that included 1297 patients with ARDS showed that 28-day mortality was significantly reduced by lung-protective ventilation, with a risk ratio (RR) of 0.74 (95% confidence interval 0.61–0.88) 5. Several randomized controlled trials (RCTs) that have analyzed the usefulness of lowering the tidal volume have shown inconsistent results 11– 16. On the contrary, lowering the tidal volume might also cause lung damage due to atelectasis, hypoxia, hypercapnia, patient discomfort, increased use of sedation, and cyclic atelectasis 10. Limiting the tidal volume results in lower levels of systemic inflammatory mediators 6 and might prevent VILI by minimizing pressure-related and capacity damage 7– 9. ![]() Limiting the tidal volume is one of the strategies of lung protection that help in reducing adverse events due to mechanical ventilation 4, 5. One of the most important aspects of ventilation management is minimizing pressure-related damage (barotrauma), capacity damage (volutrauma), and ventilator-induced lung injury (VILI) 2– 4. Trial registration: UMIN-CTR (UMIN000041071).Īcute respiratory distress syndrome (ARDS) is a life-threatening condition due to respiratory failure, often requiring mechanical ventilation for survival 1. Our study indicated that ventilation with LTV was associated with reduced risk of mortality in patients with ARDS when compared with HTV. Subgroup-analysis by combined high positive end-expiratory pressure with LTV showed interaction (P = 0.01). When comparing LTV (4–8 ml/kg) versus HTV (> 8 ml/kg), the pooled risk ratio for 28-day mortality was 0.79 (11 studies, 95% confidence interval 0.66–0.94, I 2 = 43%, n = 1795, moderate certainty of evidence). Among the 19,864 records screened, 13 RCTs that recruited 1874 patients were included in our meta-analysis. We used the GRADE methodology to assess the certainty of evidence. The primary outcomes were 28-day mortality. Two authors independently evaluated the eligibility of studies and extracted the data. We included randomized controlled trials (RCTs) to compare the LTV strategy with the higher tidal volume ventilation (HTV) strategy in patients with ARDS. We performed a literature search on MEDLINE, CENTRAL, EMBASE, CINAHL, “Igaku-Chuo-Zasshi”, clinical trial registration sites, and the reference of recent guidelines. This systematic review and meta-analysis aimed to evaluate the use of LTV strategy in patients with ARDS. The effects of lower tidal volume ventilation (LTV) were controversial for patients with acute respiratory distress syndrome (ARDS). ![]()
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