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Tidal volume reduction in patients with acute lung injury when plateau pressures are not high.
Am J Respir Crit Care Med. 2005 Nov 15; 172(10):1241-5.AJ

Abstract

Use of a volume- and pressure-limited mechanical ventilation strategy improves clinical outcomes of patients with acute lung injury and acute respiratory distress syndrome (ALI/ARDS). However, the extent to which tidal volumes and inspiratory airway pressures should be reduced to optimize clinical outcomes is a controversial topic. This article addresses the question, "Is there a safe upper limit to inspiratory plateau pressure in patients with ALI/ARDS?" We reviewed data from animal models with and without preexisting lung injury, studies of normal human respiratory system mechanics, and the results of five clinical trials of lung-protective mechanical ventilation strategies. We also present an original analysis of data from the largest of the five clinical trials. The available data from each of these assessments do not support the commonly held view that inspiratory plateau pressures of 30 to 35 cm H2O are safe. We could not identify a safe upper limit for plateau pressures in patients with ALI/ARDS.

Authors+Show Affiliations

Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. dhager1@jhmi.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Review

Language

eng

PubMed ID

16081547

Citation

Hager, David N., et al. "Tidal Volume Reduction in Patients With Acute Lung Injury when Plateau Pressures Are Not High." American Journal of Respiratory and Critical Care Medicine, vol. 172, no. 10, 2005, pp. 1241-5.
Hager DN, Krishnan JA, Hayden DL, et al. Tidal volume reduction in patients with acute lung injury when plateau pressures are not high. Am J Respir Crit Care Med. 2005;172(10):1241-5.
Hager, D. N., Krishnan, J. A., Hayden, D. L., & Brower, R. G. (2005). Tidal volume reduction in patients with acute lung injury when plateau pressures are not high. American Journal of Respiratory and Critical Care Medicine, 172(10), 1241-5.
Hager DN, et al. Tidal Volume Reduction in Patients With Acute Lung Injury when Plateau Pressures Are Not High. Am J Respir Crit Care Med. 2005 Nov 15;172(10):1241-5. PubMed PMID: 16081547.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tidal volume reduction in patients with acute lung injury when plateau pressures are not high. AU - Hager,David N, AU - Krishnan,Jerry A, AU - Hayden,Douglas L, AU - Brower,Roy G, AU - ,, Y1 - 2005/08/04/ PY - 2005/8/6/pubmed PY - 2006/7/6/medline PY - 2005/8/6/entrez SP - 1241 EP - 5 JF - American journal of respiratory and critical care medicine JO - Am. J. Respir. Crit. Care Med. VL - 172 IS - 10 N2 - Use of a volume- and pressure-limited mechanical ventilation strategy improves clinical outcomes of patients with acute lung injury and acute respiratory distress syndrome (ALI/ARDS). However, the extent to which tidal volumes and inspiratory airway pressures should be reduced to optimize clinical outcomes is a controversial topic. This article addresses the question, "Is there a safe upper limit to inspiratory plateau pressure in patients with ALI/ARDS?" We reviewed data from animal models with and without preexisting lung injury, studies of normal human respiratory system mechanics, and the results of five clinical trials of lung-protective mechanical ventilation strategies. We also present an original analysis of data from the largest of the five clinical trials. The available data from each of these assessments do not support the commonly held view that inspiratory plateau pressures of 30 to 35 cm H2O are safe. We could not identify a safe upper limit for plateau pressures in patients with ALI/ARDS. SN - 1073-449X UR - https://www.unboundmedicine.com/medline/citation/16081547/full_citation L2 - http://www.atsjournals.org/doi/full/10.1164/rccm.200501-048CP?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -