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Intensive Care Medicine

, Volume 40, Issue 7, pp 950–957 | Cite as

Association between tidal volume size, duration of ventilation, and sedation needs in patients without acute respiratory distress syndrome: an individual patient data meta-analysis

  • Ary Serpa NetoEmail author
  • Fabienne D. Simonis
  • Carmen S. V. Barbas
  • Michelle Biehl
  • Rogier M. Determann
  • Jonathan Elmer
  • Gilberto Friedman
  • Ognjen Gajic
  • Joshua N. Goldstein
  • Janneke Horn
  • Nicole P. Juffermans
  • Rita Linko
  • Roselaine Pinheiro de Oliveira
  • Sugantha Sundar
  • Daniel Talmor
  • Esther K. Wolthuis
  • Marcelo Gama de Abreu
  • Paolo Pelosi
  • Marcus J. Schultz
Original

Abstract

Purpose

Mechanical ventilation with lower tidal volumes (≤6 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 (≤6 ml/kg PBW, 6–10 ml/kg PBW, or ≥10 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 ≤6 ml/kg PBW compared to those ventilated with tidal volume ≥10 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.

Keywords

Mechanical ventilation Sedation Analgesia Meta-analysis 

Notes

Conflicts of interest

The authors declare that they have no conflict of interest.

Supplementary material

134_2014_3318_MOESM1_ESM.docx (578 kb)
Supplementary material 1 (DOCX 577 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2014

Authors and Affiliations

  • Ary Serpa Neto
    • 1
    • 2
    • 3
    Email author
  • 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. 1.Department of Intensive Care, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  2. 2.Medical Intensive Care UnitABC Medical School (FMABC)Santo AndréBrazil
  3. 3.Department of Critical Care MedicineHospital Israelita Albert EinsteinSão PauloBrazil
  4. 4.Division of Pulmonary and Critical Care MedicineMayo ClinicRochesterUSA
  5. 5.Department of Critical Care MedicineUniversity of Pittsburgh Medical CenterPittsburghUSA
  6. 6.School of MedicineUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
  7. 7.Department of Anaesthesia and Intensive Care MedicineHelsinki University Hospital, Peijas HospitalVantaaFinland
  8. 8.Medical SchoolUniversidade Federal de Ciências da Saúde de Porto AlegrePorto AlegreBrazil
  9. 9.Department of Anesthesia, Critical Care and Pain MedicineBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonUSA
  10. 10.Department of Anesthesiology and Intensive Care MedicineUniversity Hospital Carl Gustav CarusDresdenGermany
  11. 11.Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino ISTUniversity of GenoaGenoaItaly
  12. 12.Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands

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