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[Clinical effects of low-stretch ventilation on acute respiratory distress syndrome].
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2009 Oct; 21(10):609-12.ZW

Abstract

OBJECTIVE

To investigate the effectiveness of low-stretch as compared with low-tidal-volume strategy in the treatment of acute respiratory distress syndrome (ARDS).

METHODS

Eighty-five cases of ARDS patients were randomly divided into low-stretch group (42 cases) and low-tidal-volume group (43 cases). The former group of patient received pressure assist control mode with not higher than 35 cm H(2)O (1 cm H(2)O=0.098 kPa) of peak pressure or pressure support mode ventilation with not higher than 30 cm H(2)O of Pplateau, while in low-tidal-volume group tidal volume of no more than 6 ml/kg of predicted body weight was given. The mortality rate within 28 days, the incidence of hypercapnia, the duration of using sedatives and neuromuscular blockade agents, the time of ventilation and the length of intensive care unit (ICU) stay were compared between two groups. According to the monitored expiratory tidal volume (V(T)e), the low-stretch group was divided into low-tidal-volume subgroup (V(T)e < or =6 ml/kg, 11 cases) and non-low-tidal-volume subgroup (V(T)e >6 ml/kg, 31 cases). The mortality within 28 days and the incidence of hypercapnia were compared between two subgroups.

RESULTS

There was no significant difference in the 28-day mortality rate between two groups (34.0% vs. 37.0%, P>0.05), but patients of low-stretch group had lower incidence of hypercapnia than low-tidal-volume group (10.6% vs. 40.7%, P<0.05), and also the duration of using sedatives [(4.5+/-1.2) days vs. (8.7+/-2.3) days] and neuromuscular blockade agents [(8.4+/-2.1) days vs. (10.7+/-1.2) days], and the length of ventilation and ICU stay [(10.2+/-2.2) days vs. (13.7+/-3.1) days, all P<0.05] were less. Low tidal volume occurred in 26.2% of low-stretch group, and the low-tidal-volume subgroup had higher 28-day mortality rate (40.8%) and incidence of hypercapnia (65.7%) than non-low-tidal-volume subgroup (13.2% and 8.6%, both P<0.05).

CONCLUSION

Compared with low-tidal-volume strategy, low-stretch strategy can reduce the incidence of hypercapnia, the length of ventilation and ICU stay for ARDS patients, but have similar mortality rate. When low-stretch strategy is exercised, an inappropriate low tidal volume may be associated with poor outcome of ARDS.

Authors+Show Affiliations

Intensive Care Unit, the People's Second Hospital of Liaocheng, Linqing 252601, Shandong, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article
Randomized Controlled Trial

Language

chi

PubMed ID

19846008

Citation

Sun, Jia-jun, et al. "[Clinical Effects of Low-stretch Ventilation On Acute Respiratory Distress Syndrome]." Zhongguo Wei Zhong Bing Ji Jiu Yi Xue = Chinese Critical Care Medicine = Zhongguo Weizhongbing Jijiuyixue, vol. 21, no. 10, 2009, pp. 609-12.
Sun JJ, Yang MW, Wang CH, et al. [Clinical effects of low-stretch ventilation on acute respiratory distress syndrome]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2009;21(10):609-12.
Sun, J. J., Yang, M. W., Wang, C. H., Li, C. H., Qin, W. H., Li, Y. L., Liu, Q. Y., & Li, J. X. (2009). [Clinical effects of low-stretch ventilation on acute respiratory distress syndrome]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue = Chinese Critical Care Medicine = Zhongguo Weizhongbing Jijiuyixue, 21(10), 609-12.
Sun JJ, et al. [Clinical Effects of Low-stretch Ventilation On Acute Respiratory Distress Syndrome]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2009;21(10):609-12. PubMed PMID: 19846008.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Clinical effects of low-stretch ventilation on acute respiratory distress syndrome]. AU - Sun,Jia-jun, AU - Yang,Mao-wu, AU - Wang,Chang-hui, AU - Li,Chen-hua, AU - Qin,Wei-hua, AU - Li,Ya-lin, AU - Liu,Qing-yue, AU - Li,Jin-xiu, PY - 2009/10/23/entrez PY - 2009/10/23/pubmed PY - 2010/11/3/medline SP - 609 EP - 12 JF - Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue JO - Zhongguo Wei Zhong Bing Ji Jiu Yi Xue VL - 21 IS - 10 N2 - OBJECTIVE: To investigate the effectiveness of low-stretch as compared with low-tidal-volume strategy in the treatment of acute respiratory distress syndrome (ARDS). METHODS: Eighty-five cases of ARDS patients were randomly divided into low-stretch group (42 cases) and low-tidal-volume group (43 cases). The former group of patient received pressure assist control mode with not higher than 35 cm H(2)O (1 cm H(2)O=0.098 kPa) of peak pressure or pressure support mode ventilation with not higher than 30 cm H(2)O of Pplateau, while in low-tidal-volume group tidal volume of no more than 6 ml/kg of predicted body weight was given. The mortality rate within 28 days, the incidence of hypercapnia, the duration of using sedatives and neuromuscular blockade agents, the time of ventilation and the length of intensive care unit (ICU) stay were compared between two groups. According to the monitored expiratory tidal volume (V(T)e), the low-stretch group was divided into low-tidal-volume subgroup (V(T)e < or =6 ml/kg, 11 cases) and non-low-tidal-volume subgroup (V(T)e >6 ml/kg, 31 cases). The mortality within 28 days and the incidence of hypercapnia were compared between two subgroups. RESULTS: There was no significant difference in the 28-day mortality rate between two groups (34.0% vs. 37.0%, P>0.05), but patients of low-stretch group had lower incidence of hypercapnia than low-tidal-volume group (10.6% vs. 40.7%, P<0.05), and also the duration of using sedatives [(4.5+/-1.2) days vs. (8.7+/-2.3) days] and neuromuscular blockade agents [(8.4+/-2.1) days vs. (10.7+/-1.2) days], and the length of ventilation and ICU stay [(10.2+/-2.2) days vs. (13.7+/-3.1) days, all P<0.05] were less. Low tidal volume occurred in 26.2% of low-stretch group, and the low-tidal-volume subgroup had higher 28-day mortality rate (40.8%) and incidence of hypercapnia (65.7%) than non-low-tidal-volume subgroup (13.2% and 8.6%, both P<0.05). CONCLUSION: Compared with low-tidal-volume strategy, low-stretch strategy can reduce the incidence of hypercapnia, the length of ventilation and ICU stay for ARDS patients, but have similar mortality rate. When low-stretch strategy is exercised, an inappropriate low tidal volume may be associated with poor outcome of ARDS. SN - 1003-0603 UR - https://www.unboundmedicine.com/medline/citation/19846008/[Clinical_effects_of_low_stretch_ventilation_on_acute_respiratory_distress_syndrome]_ L2 - http://www.cccm-em120.com/weizhongbingguokan/21/609.pdf DB - PRIME DP - Unbound Medicine ER -