Effect of Lowering Vt on Mortality in Acute Respiratory Distress Syndrome Varies with Respiratory System Elastance

Goligher et al. examine whether the mortality benefit of ventilation with lower Vt varies according to respiratory system elastance (Ers). In a secondary analysis of patients from five randomized trials of lower- versus higher-Vt ventilation strategies in ARDS and acute hypoxemic respiratory failure...

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Bibliographic Details
Published inAmerican journal of respiratory and critical care medicine Vol. 203; no. 11; pp. 1378 - 1385
Main Authors Goligher, Ewan C, Costa, Eduardo L V, Yarnell, Christopher J, Brochard, Laurent J, Stewart, Thomas E, Tomlinson, George, Brower, Roy G, Slutsky, Arthur S, Amato, Marcelo P B
Format Journal Article
LanguageEnglish
Published New York American Thoracic Society 01.06.2021
Subjects
Clinical trials
Critical care
Mortality
Respiratory distress syndrome
Ventilation
Ventilators
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Summary:Goligher et al. examine whether the mortality benefit of ventilation with lower Vt varies according to respiratory system elastance (Ers). In a secondary analysis of patients from five randomized trials of lower- versus higher-Vt ventilation strategies in ARDS and acute hypoxemic respiratory failure, the posterior probability of an interaction between the randomized Vt strategy and Ers on 60-day mortality was computed using Bayesian multivariable logistic regression. The mortality benefit of ventilation with lower Vt in ARDS varies according to elastance, suggesting that lung-protective ventilation strategies should primarily target driving pressure rather than Vt.
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ISSN:1073-449X
1535-4970
DOI:10.1164/rccm.202009-3536OC