Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury a preventive randomized controlled trial 英文参考文献.docVIP

Determann et al. Critical Care 2010, 14:R1 /content/14/1/R1 RESEARCH Open Access Ventilation with lower tidal volumes as compared Research with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial Rogier M Determann1,2, Annick Royakkers3,4, Esther K Wolthuis1,5, Alexander P Vlaar1, 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 = 0.01)). The trial was stopped prematurely for safety reasons because the development of lung injury was higher in the conventional tidal-volume