Intensive Care Medicine

, Volume 39, Issue 1, pp 6–15

Prophylactic protective ventilation: lower tidal volumes for all critically ill patients?

Review

Abstract

High tidal volumes have historically been recommended for mechanically ventilated patients during general anesthesia. High tidal volumes have been shown to increase morbidity and mortality in patients suffering from acute respiratory distress syndrome (ARDS). Barriers exist in implementing a tidal volume reduction strategy related to the inherent difficulty in changing one's practice patterns, to the current need to individualize low tidal volume settings only for a specific subgroup of mechanically ventilated patients (i.e., ARDS patients), the difficulty in determining the predicated body weight (requiring the patient's height and a complex formula). Consequently, a protective ventilation strategy is often under-utilized as a therapeutic option, even in ARDS. Recent data supports the generalization of this strategy prophylactically to almost all mechanically ventilated patients beginning immediately following intubation. Using tools to rapidly and reliably determine the predicted body weight (PBW), as well as the use of automated modes of ventilation are some of the potential solutions to facilitate the practice of protective ventilation and to finally ventilate our patients’ lungs in a more gentle fashion to help prevent ARDS.

Keywords

Protective ventilation Acute lung injury Acute respiratory distress syndrome Mechanical ventilation Low tidal volume Predicted body weight 

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2012

Authors and Affiliations

  1. 1.Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de QuebecUniversité LavalQuebecCanada
  2. 2.Adult Critical Care, Jewish General Hospital, McGill UniversityMontréalCanada

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