tailieunhanh - Báo cáo y học: "Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial. | Determann et al. Critical Care 2010 14 R1 http content 14 1 R1 c CRITICAL CARE RESEARCH Open Access Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury a preventive randomized controlled trial Rogier M Determann 1 2 Annick Royakkers3 4 Esther KWolthuis1 5 Alexander PVlaar1 Goda Choi1 2 Frederique Paulus1 Jorrit-Jan Hofstra1 4 Mart J de Graaff1 Johanna C Korevaar6 and Marcus J Schultz 1 7 Abstract Introduction Recent cohort studies have identified the use of large tidal volumes as a major risk factor for development of lung injury in mechanically ventilated patients without acute lung injury ALI . We compared the effect of conventional with lower tidal volumes on pulmonary inflammation and development of lung injury in critically ill patients without ALI at the onset of mechanical ventilation. Methods We performed a randomized controlled nonblinded preventive trial comparing mechanical ventilation with tidal volumes of 10 ml versus 6 ml per kilogram of predicted body weight in critically ill patients without ALI at the onset of mechanical ventilation. The primary end point was cytokine levels in bronchoalveolar lavage fluid and plasma during mechanical ventilation. The secondary end point was the development of lung injury as determined by consensus criteria for ALI duration of mechanical ventilation and mortality. Results One hundred fifty patients 74 conventional versus 76 lower tidal volume were enrolled and analyzed. No differences were observed in lavage fluid cytokine levels at baseline between the randomization groups. Plasma interleukin-6 IL-6 levels decreased significantly more strongly in the lower-tidal-volume group from 51 20 to 182 ng ml to 11 5 to 20 ng ml versus 50 21 to 122 ng ml to 21 20 to 77 ng ml P . The trial was stopped prematurely for safety reasons because the development of lung injury was higher in the conventional tidal-volume group as compared with the .