Association between tidal volume size, duration of ventilation, and sedation needs in patients without acute respiratory distress syndrome: an individual patient data meta-analysis
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- 作者：Ary Serpa Neto (1) (2) (3)
Fabienne D. Simonis (1)
Carmen S. V. Barbas (1)
Michelle Biehl (4)
Rogier M. Determann (1)
Jonathan Elmer (5)
Gilberto Friedman (6)
Ognjen Gajic (4)
Joshua N. Goldstein (5)
Janneke Horn (1)
Nicole P. Juffermans (1)
Rita Linko (7)
Roselaine Pinheiro de Oliveira (8)
Sugantha Sundar (9)
Daniel Talmor (9)
Esther K. Wolthuis (1)
Marcelo Gama de Abreu (10)
Paolo Pelosi (11)
Marcus J. Schultz (1) (12) - 关键词：Mechanical ventilation ; Sedation ; Analgesia ; Meta ; analysis
- 刊名：Intensive Care Medicine
- 出版年：2014
- 出版时间：July 2014
- 年：2014
- 卷：40
- 期：7
- 页码：950-957
- 全文大小：
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Fabienne D. Simonis (1)
Carmen S. V. Barbas (1)
Michelle Biehl (4)
Rogier M. Determann (1)
Jonathan Elmer (5)
Gilberto Friedman (6)
Ognjen Gajic (4)
Joshua N. Goldstein (5)
Janneke Horn (1)
Nicole P. Juffermans (1)
Rita Linko (7)
Roselaine Pinheiro de Oliveira (8)
Sugantha Sundar (9)
Daniel Talmor (9)
Esther K. Wolthuis (1)
Marcelo Gama de Abreu (10)
Paolo Pelosi (11)
Marcus J. Schultz (1) (12)
1. Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
2. Medical Intensive Care Unit, ABC Medical School (FMABC), Santo André, Brazil
3. Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Albert Einstein Avenue, 700, S?o Paulo, Brazil
4. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
5. Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
6. School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
7. Department of Anaesthesia and Intensive Care Medicine, Helsinki University Hospital, Peijas Hospital, Vantaa, Finland
8. Medical School, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
9. Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
10. Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
11. Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino IST, University of Genoa, Genoa, Italy
12. Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands - ISSN：1432-1238
文摘
Purpose Mechanical ventilation with lower tidal volumes (??ml/kg of predicted body weight, PBW) could benefit patients without acute respiratory distress syndrome (ARDS). However, tidal volume reduction could be associated with increased patient discomfort and sedation needs, and consequent longer duration of ventilation. The aim of this individual patient data meta-analysis was to assess the associations between tidal volume size, duration of mechanical ventilation, and sedation needs in patients without ARDS. Methods Studies comparing ventilation with different tidal volume sizes in patients without ARDS were screened for inclusion. Corresponding authors were asked to provide individual participant data. Patients were assigned to three groups based on tidal volume size (??ml/kg PBW, 6-0?ml/kg PBW, or ?0?ml/kg PBW). Ventilator-free days, alive at day 28, and dose and duration of sedation (propofol and midazolam), analgesia (fentanyl and morphine), and neuromuscular blockade (NMB) were compared. Results Seven investigations (2,184 patients) were included in the analysis. The number of patients breathing without assistance by day 28 was higher in the group ventilated with tidal volume ??ml/kg PBW compared to those ventilated with tidal volume ?0?ml/kg PBW (93.1 vs. 88.6?%; p?=?0.027, respectively). Only two investigations (187 patients) could be included in the meta-analysis of sedation needs. There were neither differences in the percentage of study days that patients received sedatives, opioids, or NMBA nor in the total dose of benzodiazepines, propofol, opioids, and NMBA. Conclusions This meta-analysis suggests that use of lower tidal volumes in patients without ARDS at the onset of mechanical ventilation could be associated with shorter duration of ventilation. Use of lower tidal volumes seems not to affect sedation or analgesia needs, but this must be confirmed in a robust, well-powered randomized controlled trial.