Low tidal volumes with recruitment manoeuvres and high PEEP
Control
Established low-tidal-volume strategy
Population
983 patients, 85% of whom met ARDS criteria at enrolment
Follow-up
Hospital discharge
Primary endpoint
All-cause hospital mortality
Result
Tidal volumes were similar between groups; mean PEEP was 14.6±3.4 cmH2O in the experimental group versus 9.8±2.7 in the control group. There was no significant difference in all-cause hospital mortality or in barotrauma.
Secondary endpoints
Barotrauma, refractory hypoxaemia, rescue therapy use
For patients with acute lung injury and acute respiratory distress syndrome, a multifaceted protocolized ventilation strategy designed to recruit and open the lung resulted in no significant difference in all-cause hospital mortality or barotrauma compared with an established low-tidal-volume strategy.
The trial authors, in the published abstract
How it has aged
Reassuring on safety where ART later was not — no excess barotrauma — but equally unable to show benefit. Its consistency with ALVEOLI and ExPress is what makes the trio persuasive.
Publications
Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial
Meade MO, Cook DJ, Guyatt GH, et al. Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA 2008 Feb 13;299(6):637-45.
No difference in all-cause hospital mortality
No excess barotrauma with the open lung strategy
Less need for rescue therapy in the experimental arm