Protective mechanical ventilation: revision of randomized clinical trials

• Main Author: Valle Pinheiro, Bruno
• Publication Date: 2019
• Other Authors: Bastos Netto, Cristiane, Souza Vieira, Rodrigo, Pinto Botelho, Mateus, de Moura Lopes, Gabrielle, Moura Reboredo, Maycon
• Format: Article
• Language: por
• Source: HU Revista (Online)
• Download full: https://periodicos.ufjf.br/index.php/hurevista/article/view/28988
• topic: Respiration, Artificial; Lung Injury; Mortality; Respiração Artificial; Lesão Pulmonar; Mortalidade

Introduction: Mechanical ventilation can be a life-saving strategy in patients with respiratory failure. However, it is potentially dangerous and can induce a so-called ventilator-induced lung injury (VILI). This revision aimed to analyze the results of randomized clinical trials (RCT) that evaluated the impact of ventilatory settings on mortality. Material and methods: We search in PubMed for RCT, published from 1980 to 2019, using the following MeSH terms: “respiratory distress syndrome, adult” and “respiration, artificial”. We selected the RCT that compared different ventilatory settings and had mortality as an outcome. Results: In patients with acute respiratory distress syndrome (ARDS), it has been demonstrated that limiting tidal volume, plateau pressure, and driving pressure reduced mortality. In severe ARDS, the use of higher PEEP and prone position also reduced mortality. Among non-ARDS patients, it is still uncertain if any strategy is associated with better survival rates. Conclusion: In ARDS patients, one has to be aware of setting the ventilatory parameters because protective settings can improve survival.