CoChat
Sign Up
Cited by 104Respiratory Support and MechanismsNeonatal Respiratory Health ResearchNosocomial Infections in ICU

Effects of a Clinical Trial on Mechanical Ventilation Practices in Patients with Acute Lung Injury

Open access
Checkley, William, Brower, Roy, Korpak, Anna, Thompson, B. Taylor·2008·American Journal of Respiratory and Critical Care Medicine
DOI 10.1164/rccm.200709-1424ocPMC PMC2408439
Open this paper in CoChat — free account

Abstract

Rationale: In a clinical trial by the Acute Respiratory Distress Syndrome Network (ARDSNet), mechanical ventilation with tidal volumes of 6 ml/kg decreased mortality from acute lung injury. However, interpretations of these results generated controversy and it was unclear if this trial would change usual-care practices. Objectives: First, to determine if clinical practices at ARDSNet hospitals changed after the tidal volume trial. Second, to determine if tidal volume and plateau pressure (Pplat) within 48 hours before randomization affected hospital mortality in patients subsequently managed with 6 ml/kg predicted body weight (PBW). Methods: We used preenrollment data from 2,451 patients enrolled in six trials (1996–2005) to describe changes in tidal volume over time. We used logistic regression to determine if preenrollment tidal volume or Pplat affected mortality. Measurements and Main Results: Median preenrollment tidal volume decreased from 10.3 ml/kg PBW (range, 4.3–17.1) during the tidal volume trial (1996–1999) to 7.3 ml/kg PBW (range, 3.9–16.2) after its completion (P < 0.001). Preenrollment tidal volume was not associated with mortality (P = 0.566). The odds of death increased multiplicatively with each cm H2O of preenrollment Pplat (P < 0.001) (e.g., the odds of death was 1.37 times greater when preenrollment Pplat increased by 10 cm H2O). Conclusions: Physicians used lower tidal volumes after publication of the tidal volume trial. Preenrollment Pplat was strongly associated with mortality, and may reflect disease severity independent of tidal volume. Pplat measured early in the course of acute lung injury, after accounting for tidal volume, is a respiratory system–specific value with strong prognostic significance.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1164/rccm.200709-1424oc

Cites

40 of 40 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Several meta-analyses suggest decreased mortality in patients with a pressure-and volume-limited strategy for established ARDS.

    “Several meta-analyses suggest decreased mortality in patients with a pressure-and volume-limited strategy for established ARDS (353,354).”

    From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [353]

    The Abstract reports that an ARDSNet trial found lower hospital mortality with lower tidal volumes, and the Discussion links early plateau pressure to mortality. But this paper studies changes in ventilation practice, not the results of several meta-analyses, and it does not establish a mortality benefit for a combined pressure- and volume-limited strategy in established ARDS. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • 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 [432]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

1 of the 41 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

  1. [9]The ARDS Network. Ketoconazole for early treatment of acute lung injury and ARDS: a randomized controlled trial. JAMA 2000;283:1995–2002. [DOI] [PubMed] [Google Scholar]
  2. [11]Brower RG, Lanken PN, MacIntyre N, Matthay MA, Morris A, Ancukiewicz M, Schoenfeld D, Thompson BT; National Heart, Lung, and Blood Institute ARDS Clinical Trials Network. Higher versus lower positive end-expiratory pressures in patients with the ARDS. N Engl J Med 2004;351:327–336. [DOI] [PubMed] [Google Scholar]
  3. [14]Checkley W, Brower RG, Korpak A, Thompson BT. Effects of early management of mechanical ventilation (MV) on hospital mortality in patients with acute lung injury. Am J Respir Crit Care Med 2007;175:A245. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. [20]Agresti A. Categorical data analysis, 2nd ed. Hoboken, NJ: John Wiley & Sons; 2002. pp. 168, 175, 219.

Cited by

Sorted by citations

Related

Authors
Checkley, W., Brower, R., Korpak, A., & Thompson, B. T.
Affiliations
  • Johns Hopkins University (US)
  • Harvard University (US)
ORCID
Venue
American Journal of Respiratory and Critical Care Medicine
Publisher
Oxford University Press (OUP)
Published
2008-06-01
Volume
177
Issue
11
Pages
1215-1222
ISSN
  • 1073-449X (ISSN-L)
  • 1535-4970
DOI
10.1164/rccm.200709-1424oc
PMC
PMC2408439
OpenAlex
W2021668188
Cited by
104
References
41
Citations by year
2026: 3 · 2025: 1 · 2024: 1 · 2023: 2 · 2022: 4 · 2021: 6 · 2020: 3 · 2019: 6 · 2018: 3 · 2017: 7 · 2016: 7 · 2015: 9 · 2014: 7 · 2013: 17 · 2012: 7
FWCI
6.36
Type
journal article
Language
en
Open access
Licence
academic.oup.com/pages/standard-publication-reuse-rights (vor)
Locations
  • American Journal of Respiratory and Critical Care Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • American Thoracic Society
  • National Institutes of Health (5f32hl090179-02, n01hr016146-000, NO1-HR-46046-64)
  • National Heart, Lung, and Blood Institute (N01-HR46046-64, N01-HR-16146-54, 1F32HL090179-01)
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, mechanical ventilation, tidal volume, plateau pressure, ARDSNet, clinical practice change, in-hospital mortality, prognostic factors, disease severity, ventilator-induced lung injury
MeSH terms
Airway Resistance, Clinical Trials as Topic, Humans, Practice Patterns, Physicians', Respiration, Artificial, Respiratory Distress Syndrome, Retrospective Studies, Tidal Volume, Cohort Studies, Logistic Models, Odds Ratio, Hospital Mortality

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review