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PART 4: Pulmonary Disorders
Clinical Trials Evaluating the Effects of Different Lung-Protective Strategies Using Conventional Mechanical Ventilation on Outcome in Acute Respiratory Distress Syndrome
Recruitment
PEEP, cm H 2 O
Intervention Outcome Control Intervention Control A, B, D None Yes Not reported P-Flex Not reported P-Flex No differences None None 10.8 ± 2.7 (day 2) 10.6 ± 3.2 (day 2) No differences None None 8.4 ± 3.8 (day 3) 8.7 ± 3.6 (day 3) No differences None None 8 (day 3) 8 (day 3) A, C None None 8.6 ± 4.2 (day 3) 9.2 ± 3.6 (day 3) No differences in mortality; None Yes Same as ARDSNet trial Goal of 2-6 cm H 2 O > controls unpublished A None None PEEP > 5 cm H 2 O PEEP 2 cm H 2 O above LIP No differences in mortality None Yes Same as ARDSNet trial High PEEP/Fi O
Not reported Goal >12 10.3 ± 1.7 (day 1) 10.8 ± 1.0 (day 3) 10.2 ± 0.1 (day 5) 11.8 ± 0.8 (day 3) 6.1 ± 1.1 (day 3) 10.0 ± 1 (day 3) 6.7 ± 1.5 (day 3) 6.2 ± 0.6 (day 3)

Tidal Volumes, mL/kg Control A = Reduction in mortality compared to conventional group. B = Improvement in physiological parameters (oxygenation and compliance). C = Reduction in inflammatory mediators. D = Reduction in barotrauma.

Intervention Not reported Goal <6 7.1 ± 1.3 (day 1) 7.2 ± 0.8 (day 3) 7.3 ± 0.1 (day 5) 6.2 ± 0.8 (day 3) 5.8 ± 1 (day 3) 7.1 ± 0.9 (day 3) 6.9 ± 1.5 (day 3) 6.2 ± 0.5 (day 3)

Intervention Used Low stretch, lung open; using P-V curve a Low stretch Low stretch Low stretch Low stretch Low stretch, lung open Low stretch, open lung using P-V curve Low stretch, lung open; present PEEP levels depending on Fi O 2 Low stretch, open lung a PEEP was adjusted in the intervention arm to 2 to 4 cm H 2 O greater than the lower inflection point (P-Flex).

ALVEOLI (n = 550) stopped Villar (n = 103) stopped early PEEP, positive end-expiratory pressure; FiO 2 , fraction of inspired oxygen.
TABLE 51-3 Amato (n = 53) 101 Brochard (n = 116) 113 Stewart (n = 120) 115 Brower (n = 52) 114 ARDS Network (n = 861) 2 for efficacy 102 LOVS trial (n = 983) 16 EXPRESS trial (n = 768) 17

Study early 119

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