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New study examines Ventilator Treatment
Strategies for patients with severe
Respiratory Disorders
Newswise — A
comparison of two treatment methods for
critically ill patients with severe,
rapid-onset lung disorders treated with
mechanical ventilators found no significant
difference in the risk of death, but did
find that the newer method reduced the rates
of severe persistent low oxygen levels and
reduced the need for additional “rescue”
therapies, according to a study in the
February 13 issue of JAMA.
Acute lung injury (such
as from severe pneumonia or trauma) and
acute respiratory distress syndrome (ARDS;
the most serious form of acute lung injury),
can be devastating complications of critical
illness.
Although mechanical ventilation
provides essential life support, it can
worsen lung injury.
Low tidal volume (volume
of air that is drawn with each breath)
ventilation reduces the risk of death in
critically ill patients with acute lung
injury and ARDS. Adding therapies to
effectively splint open collapsed lung
segments may further reduce the risk of
death, the authors write.
Maureen O. Meade, M.D.,
M.Sc., of Hamilton Health Sciences and
McMaster University, Hamilton, Ontario,
Canada, and colleagues examined the effect
on death of an experimental “lung open
ventilation” (LOV) strategy combining low
tidal volumes, recruitment maneuvers
(periodic sighs on the ventilator to open
the lung) and high levels of positive
end-expiratory pressure (PEEP; to keep the
lung open) compared with an established
low-tidal-volume strategy (control group) in
983 patients with moderate and severe lung
injury.
The randomized trial (the LOV study)
was conducted between August 2000 and March
2006 in 30 intensive care units in Canada,
Australia and Saudi Arabia.
All-cause hospital
death rates were 36.4 percent in the
experimental group and 40.4 percent in the
control group. Barotrauma rates (injury to
the lung caused by the pressure of the
ventilator) were 11.2 percent and 9.1
percent, respectively.
“… for patients with
acute lung injury and ARDS, we found similar
mortality in patients with a multi-faceted
protocolized lung-protective ventilation
strategy designed to open the lung compared
with an established low-tidal-volume
protocolized ventilation strategy.
"We found
no evidence of significant harm or increased
risk of barotrauma despite the use of higher
PEEP. In addition, the ‘open-lung’ strategy
appeared to improve oxygenation, with fewer
hypoxemia-related deaths and a lower use of
rescue therapies by the treating clinicians.
"Our results, in combination with the two
other major trials, justify use of higher
PEEP levels as an alternative to the
established low-PEEP, low-tidal-volume
strategy,” the authors write.
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