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

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

来源：Intensive Care Medicine, 2014, 40(7): 950-957.

DOI：10.1007/s00134-014-3318-4

• Mechanical ventilation
• Sedation
• Analgesia
• Meta-analysis

Mechanical ventilation with lower tidal volumes (a parts per thousand currency sign6 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.
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 (a parts per thousand currency sign6 ml/kg PBW, 6-10 ml/kg PBW, or a parts per thousand yen10 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.
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 a parts per thousand currency sign6 ml/kg PBW compared to those ventilated with tidal volume a parts per thousand yen10 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.
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.

• 出版日期2014-7