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

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

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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

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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.

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Authors: Checkley, W., Brower, R., Korpak, A., & Thompson, B. T.
Affiliations: Johns Hopkins University (US)
Harvard University (US)
ORCID: Checkley, William
Korpak, Anna
Thompson, B. Taylor
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: green
europepmc.org
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

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

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