tetano
Editor, Senior Moderator
J Crit Care
. 2024 Sep 25:85:154921.
doi: 10.1016/j.jcrc.2024.154921. Online ahead of print. A tidal volume of 7 mL/kg PBW or higher may be safe for COVID-19 patients
Alessandro Protti[SUP] 1 [/SUP], Fabiana Madotto[SUP] 2 [/SUP], Gaetano Florio[SUP] 2 [/SUP], Tiziana Bove[SUP] 3 [/SUP], Eleonora Carlesso[SUP] 4 [/SUP], Giampaolo Casella[SUP] 5 [/SUP], Francesca Dalla Corte[SUP] 6 [/SUP], Giuseppe Foti[SUP] 7 [/SUP], Riccardo Giudici[SUP] 5 [/SUP], Thomas Langer[SUP] 8 [/SUP], Carlo Montalto[SUP] 9 [/SUP], Emanuele Rezoagli[SUP] 7 [/SUP], Alessandro Santini[SUP] 1 [/SUP], Pierpaolo Terragni[SUP] 10 [/SUP], Alberto Zanella[SUP] 11 [/SUP], Giacomo Grasselli[SUP] 12 [/SUP], Maurizio Cecconi[SUP] 1 [/SUP]
Affiliations
Purpose: The novel coronavirus disease (COVID-19) has revived the debate on the optimal tidal volume during acute respiratory distress syndrome (ARDS). Some experts recommend 6 mL/kg of predicted body weight (PBW) for all patients, while others suggest 7-9 mL/kg PBW for those with compliance >50 mL/cmH[SUB]2[/SUB]O. We investigated whether a tidal volume ≥ 7 ml/kg PBW may be safe in COVID-19 patients, particularly those with compliance >50 mL/cmH[SUB]2[/SUB]O.
Materials and methods: This secondary analysis of a multicenter study compares the Intensive Care Unit (ICU) mortality among 600 patients ventilated with <7 or ≥ 7 mL/kg PBW. Compliance was categorized as <40, 40-50, or > 50 mL/cmH[SUB]2[/SUB]O.
Results: 346 patients were ventilated with <7 (6.2 ± 0.5) mL/kg PBW and 254 with ≥7 (7.9 ± 0.9) mL/kg PBW. ICU mortality was 33 % and 29 % in the two groups (p = 0.272). At multivariable regression analysis, tidal volume ≥ 7 mL/kg PBW was associated with lower ICU mortality in the overall population (odds ratio: 0.62 [95 %-confidence interval: 0.40-0.95]) and in each compliance category.
Conclusions: A tidal volume ≥ 7 (up to 9) mL/kg PBW was associated with lower ICU mortality in these COVID-19 patients, including those with compliance <40 mL/cmH[SUB]2[/SUB]O. This finding should be interpreted cautiously due to the retrospective study design.
Trial registration: ClinicalTrails.govNCT04388670.
Keywords: Acute respiratory distress syndrome (ARDS); Coronavirus disease 2019 (COVID-19); Driving pressure; Lung protective ventilation; Mechanical ventilation; Tidal volume.
. 2024 Sep 25:85:154921.
doi: 10.1016/j.jcrc.2024.154921. Online ahead of print. A tidal volume of 7 mL/kg PBW or higher may be safe for COVID-19 patients
Alessandro Protti[SUP] 1 [/SUP], Fabiana Madotto[SUP] 2 [/SUP], Gaetano Florio[SUP] 2 [/SUP], Tiziana Bove[SUP] 3 [/SUP], Eleonora Carlesso[SUP] 4 [/SUP], Giampaolo Casella[SUP] 5 [/SUP], Francesca Dalla Corte[SUP] 6 [/SUP], Giuseppe Foti[SUP] 7 [/SUP], Riccardo Giudici[SUP] 5 [/SUP], Thomas Langer[SUP] 8 [/SUP], Carlo Montalto[SUP] 9 [/SUP], Emanuele Rezoagli[SUP] 7 [/SUP], Alessandro Santini[SUP] 1 [/SUP], Pierpaolo Terragni[SUP] 10 [/SUP], Alberto Zanella[SUP] 11 [/SUP], Giacomo Grasselli[SUP] 12 [/SUP], Maurizio Cecconi[SUP] 1 [/SUP]
Affiliations
- PMID: 39326356
- DOI: 10.1016/j.jcrc.2024.154921
Purpose: The novel coronavirus disease (COVID-19) has revived the debate on the optimal tidal volume during acute respiratory distress syndrome (ARDS). Some experts recommend 6 mL/kg of predicted body weight (PBW) for all patients, while others suggest 7-9 mL/kg PBW for those with compliance >50 mL/cmH[SUB]2[/SUB]O. We investigated whether a tidal volume ≥ 7 ml/kg PBW may be safe in COVID-19 patients, particularly those with compliance >50 mL/cmH[SUB]2[/SUB]O.
Materials and methods: This secondary analysis of a multicenter study compares the Intensive Care Unit (ICU) mortality among 600 patients ventilated with <7 or ≥ 7 mL/kg PBW. Compliance was categorized as <40, 40-50, or > 50 mL/cmH[SUB]2[/SUB]O.
Results: 346 patients were ventilated with <7 (6.2 ± 0.5) mL/kg PBW and 254 with ≥7 (7.9 ± 0.9) mL/kg PBW. ICU mortality was 33 % and 29 % in the two groups (p = 0.272). At multivariable regression analysis, tidal volume ≥ 7 mL/kg PBW was associated with lower ICU mortality in the overall population (odds ratio: 0.62 [95 %-confidence interval: 0.40-0.95]) and in each compliance category.
Conclusions: A tidal volume ≥ 7 (up to 9) mL/kg PBW was associated with lower ICU mortality in these COVID-19 patients, including those with compliance <40 mL/cmH[SUB]2[/SUB]O. This finding should be interpreted cautiously due to the retrospective study design.
Trial registration: ClinicalTrails.govNCT04388670.
Keywords: Acute respiratory distress syndrome (ARDS); Coronavirus disease 2019 (COVID-19); Driving pressure; Lung protective ventilation; Mechanical ventilation; Tidal volume.