Tidal Volume Reduction in Patients with Acute Lung Injury When Plateau Pressures Are Not High

Hager, David N.; Krishnan, Jerry A.; Hayden, Douglas L.; Brower, Roy G.

doi:10.1164/rccm.200501-048cp

Cited by 509Respiratory Support and MechanismsNeonatal Respiratory Health ResearchNosocomial Infections in ICU

Tidal Volume Reduction in Patients with Acute Lung Injury When Plateau Pressures Are Not High

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Hager, David N., Krishnan, Jerry A., Hayden, Douglas L., Brower, Roy G.·2005·American Journal of Respiratory and Critical Care Medicine

DOI 10.1164/rccm.200501-048cpPMC PMC2718413

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Abstract

Use of a volume- and pressure-limited mechanical ventilation strategy improves clinical outcomes of patients with acute lung injury and acute respiratory distress syndrome (ALI/ARDS). However, the extent to which tidal volumes and inspiratory airway pressures should be reduced to optimize clinical outcomes is a controversial topic. This article addresses the question, “Is there a safe upper limit to inspiratory plateau pressure in patients with ALI/ARDS?” We reviewed data from animal models with and without preexisting lung injury, studies of normal human respiratory system mechanics, and the results of five clinical trials of lung-protective mechanical ventilation strategies. We also present an original analysis of data from the largest of the five clinical trials. The available data from each of these assessments do not support the commonly held view that inspiratory plateau pressures of 30 to 35 cm H2O are safe. We could not identify a safe upper limit for plateau pressures in patients with ALI/ARDS.

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A retrospective study suggested that tidal volumes should be lowered even with plateau pressures ≤ 30 cm H2O because lower plateau pressures were associated with reduced hospital mortality.
“A retrospective study suggested that tidal volumes should be lowered even with plateau pressures ≤ 30 cm H2O [431] because lower plateau pressures were associated with reduced hospital mortality [432].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [431]

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Authors: Hager, D. N., Krishnan, J. A., Hayden, D. L., & Brower, R. G.
Affiliations: Johns Hopkins University (US)
ORCID: Hager, David N.
Krishnan, Jerry A.
Venue: American Journal of Respiratory and Critical Care Medicine
Publisher: Oxford University Press (OUP)
Published: 2005-11
Volume: 172
Issue: 10
Pages: 1241-1245
ISSN: 1073-449X (ISSN-L)
1535-4970
DOI: 10.1164/rccm.200501-048cp
PMC: PMC2718413
OpenAlex: W2168829312
Cited by: 509
References: 45
Citations by year: 2026: 5 · 2025: 5 · 2024: 12 · 2023: 7 · 2022: 17 · 2021: 28 · 2020: 29 · 2019: 25 · 2018: 16 · 2017: 34 · 2016: 28 · 2015: 34 · 2014: 34 · 2013: 29 · 2012: 30
FWCI: 4.59
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: academic.oup.com/pages/standard-publication-reuse-rights (vor)
Locations: American Journal of Respiratory and Critical Care Medicine (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (n01hr046063-006, n01hr046064-009)
National Heart, Lung, and Blood Institute (K23HL067850, N01-HR-46063, K23-HL67850, P50HL073944, N01-HR46064, F32HL078132)
Topics: Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
Keywords: acute lung injury, acute respiratory distress syndrome, tidal volume reduction, plateau pressure, lung-protective ventilation, pressure-limited ventilation, ventilator-induced lung injury, respiratory mechanics, animal models of lung injury
MeSH terms: Animals, Humans, Respiration, Artificial, Respiratory Distress Syndrome, Tidal Volume, Logistic Models, Models, Animal

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Tidal Volume Reduction in Patients with Acute Lung Injury When Plateau Pressures Are Not High

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