Some of the limitations of the meta-analysis were the mixed setting of mechanical ventilation (intensive care unit or operating room) and the duration of mechanical ventilation. Tidal volume gradients between the 2 groups did not influence significantly the final results.Ĭonclusions Among patients without ARDS, protective ventilation with lower tidal volumes was associated with better clinical outcomes. Meta-analysis using a random-effects model showed, in protective ventilation groups, a lower incidence of pulmonary infection (RR, 0.45 95% CI, 0.22 to 0.92 I 2, 32% NNT, 26), lower mean (SD) hospital length of stay (6.91 vs 8.87 days, respectively standardized mean difference, 0.51 95% CI, 0.20 to 0.82 I 2, 75%), higher mean (SD) Pa CO 2 levels (41.05 vs 37.90 mm Hg, respectively SMD, −0.51 95% CI, −0.70 to −0.32 I 2, 54%), and lower mean (SD) pH values (7.37 vs 7.40, respectively SMD, 1.16 95% CI, 0.31 to 2.02 I 2, 96%) but similar mean (SD) ratios of Pa O 2 to fraction of inspired oxygen (304.40 vs 312.97, respectively SMD, 0.11 95% CI, −0.06 to 0.27 I 2, 60%). The results of lung injury development were similar when stratified by the type of study (randomized vs nonrandomized) and were significant only in randomized trials for pulmonary infection and only in nonrandomized trials for mortality. Meta-analysis using a fixed-effects model showed a decrease in lung injury development (risk ratio, 0.33 95% CI, 0.23 to 0.47 I 2, 0% number needed to treat, 11), and mortality (RR, 0.64 95% CI, 0.46 to 0.89 I 2, 0% NNT, 23) in patients receiving ventilation with lower tidal volumes. Disagreement was resolved by consensus.ĭata Synthesis Twenty articles (2822 participants) were included. Study Selection Eligible studies evaluated use of lower vs higher tidal volumes in patients without ARDS at onset of mechanical ventilation and reported lung injury development, overall mortality, pulmonary infection, atelectasis, and biochemical alterations.ĭata Extraction Three reviewers extracted data on study characteristics, methods, and outcomes. Objective To determine whether use of lower tidal volumes is associated with improved outcomes of patients receiving ventilation who do not have ARDS.ĭata Sources MEDLINE, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials up to August 2012. It has been suggested that use of lower tidal volumes also benefits patients who do not have ARDS. Shared Decision Making and CommunicationĬontext Lung-protective mechanical ventilation with the use of lower tidal volumes has been found to improve outcomes of patients with acute respiratory distress syndrome (ARDS).Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.Funnel plot for the analyses of Figure 2. Standardized mean difference of time to extubation between protective and conventional.ĮFigure 8. Standardized mean difference of hospital length of stay between protective and conventional.ĮFigure 7. Standardized mean difference of ICU length of stay between protective and conventional.ĮFigure 6. Standardized mean difference of pH between protective and conventional.ĮFigure 5. Standardized mean difference of PaO2 / FiO2 between protective and conventional.ĮFigure 4. Standardized mean difference of PaCO2 between protective and conventional.ĮFigure 3. Risk ratio against tidal volume gradient.ĮFigure 2. Sensitivity analysis of quality components for the lung injury, mortality, and pulmonary infection.ĮFigure 1. GRADE evidence profile for impact of protective or conservative ventilation from systematic review and meta-analysis of randomized controlled trials only.ĮTable 6. Stratified analysis between fixed-effect and random-effect model.ĮTable 5. Mechanical ventilation settings.ĮTable 4.
Demographic, ventilatory and laboratorial characteristics of the patients in each study.ĮTable 3. Scientific quality of experimental methods.ĮTable 2. Association between use of lung-protective ventilation with lower tidal volumes and risk of acute lung injury, mortality, pulmonary infection, and atelectasis: a meta-analysis. Serpa Neto A, Cardoso SO, Manetta JA, et al.
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