2001/10/01 by Richard H Kallet, Wanda Corral, Henry J Silverman +1
paper · doi:10.1177/002013240104601005
crossref issued 2001/10/01 · crossref published 2001/10/01 · crossref published-online 2001/10/01 · crossref published-print 2001/10/01 · crossref created 2026/03/30 · crossref deposited 2026/07/07 · crossref indexed 2026/07/29
The ARDS (acute respiratory distress syndrome) Network study found 22% lower mortality in acute lung injury and ARDS patients ventilated with low tidal volumes (V T ) than in those ventilated with traditional V T ventilation. Several points should be considered when using the low V T protocol for clinical practice. Prior to implementation, hemodynamic and acid-base status, minute ventilation, and adequacy of sedation should be assessed to minimize the potential for intolerance. The volume-preset, assist-control mode is recommended for better control of V T , and the respiratory rate should be increased as V T is reduced, so as to maintain minute ventilation and prevent acute hypercapnia. When unavoidable, hypercapnia should be induced slowly. Ventilator inspiratory flow (V I ) and trigger sensitivity settings should be optimized to limit the increase in work of breathing and dyspnea. When dyspnea results in double-triggered breaths, V T can be titrated to 7-8 mL/kg, provided end-inspiratory plateau pressure is ≤ 30 cm H 2 O. In severe acidosis (pH T also can be increased. However, every effort should be made to maintain plateau pressure and V T goals by buffering severe acidosis and treating patient-ventilator asynchrony with sedation. Evaluation for weaning should occur when adequate oxygenation can be maintained on 40% oxygen and a positive end-expiratory pressure of 8 cm H 2 O. Pressure support levels between 5 and 20 cm H 2 O (above 5 cm H 2 O positive end-expiratory pressure) are used for weaning and titrated to keep the respiratory rate