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Clinical Investigations in Critical Care |

Clinicians’ Approaches to Mechanical Ventilation in Acute Lung Injury and ARDS*

B. Taylor Thompson, MD; Doug Hayden, MA; Michael A. Matthay, MD, FCCP; Roy Brower, MD; Polly E. Parsons, MD
Author and Funding Information

*From the Pulmonary and Critical Care Unit, Department of Medicine (Dr. Thompson), Department of Biostatistics (Mr. Hayden), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, the Department of Anesthesia, and the Cardiovascular Research Institute (Dr. Matthay), University of California, San Francisco, San Francisco, CA; Division of Pulmonary and Critical Care Medicine (Dr. Brower), Johns Hopkins University, Baltimore, MD; and Pulmonary and Critical Care Unit (Dr. Parsons), Fletcher Allen Health Care, Burlington, VT.

Correspondence to: B. Taylor Thompson, MD, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; e-mail: tthompson1@partners.org



Chest. 2001;120(5):1622-1627. doi:10.1378/chest.120.5.1622
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Study objectives: To examine clinicians’ approaches to mechanical ventilation in patients with acute lung injury (ALI; Pao2/fraction of inspired oxygen[ Fio2] ≤ 300) and compare ventilator settings in patients with ARDS (Pao2/Fio2 ≤ 200) to settings in patients with milder oxygenation impairment (Pao2/Fio2 of 201 to 300).

Design: Retrospective analysis of baseline data from prospective randomized trials conducted by the National Institutes of Health ARDS Network between 1996 and 1999.

Setting: Ten clinical centers comprising 24 hospitals and 74 medical and surgical ICUs of the ARDS Network.

Measurements and results: The most common mode of mechanical ventilation in both groups was volume-assist control (56%). Synchronized intermittent mandatory ventilation (SIMV) or SIMV with pressure support was used more often in patients with Pao2/Fio2 of 201 to 300 than in patients with ARDS. The use of pressure-control ventilation was uncommon (10% overall), as was the use of permissive hypercapnia (6% of patients with ARDS and 3% of patients with Pao2/Fio2 of 201 to 300). The mean ± SD tidal volume was 10.3 ± 2 mL/kg of predicted body weight or 8.6 ± 2 mL/kg of measured weight for patients with ARDS, and was not significantly different for patients with Pao2/Fio2 of 201 to 300. Plateau pressures (Pplats) were lower in the Pao2/Fio2 of 201 to 300 group (27 ± 7 vs 31 ± 8 for the ARDS group; p = 0.0003) and were > 35 cm H2O in 26% of patients. Seventy-eight percent of patients with ARDS received ≤ 10 cm H2O of positive end-expiratory pressure.

Conclusions: Physicians in ARDS Network centers caring for patients early in the course of ALI/ARDS used volume-targeted ventilation and selected tidal volumes that resulted in Pplats generally < 35 cm H2O. The average tidal volume was similar for patients with ARDS vs those with milder oxygenation deficits.

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