Lower Tidal Volumes Reduces Mortality

Many deaths of patients on ventilators could be avoided simply by giving them air in smaller breaths, researchers say in a study that was released early so doctors could use the life-saving technique immediately.
"By providing gentler breaths, we've given acutely inflamed and injured lungs a better chance of healing,'' said Dr. Roy Brower of Johns Hopkins University, who headed the study.
Researchers suggested their technique could save 3,000 lives a year, perhaps many more.
The New England Journal of Medicine released the findings on Friday in advance of the May 4 publication date. (ARDS Support Center insertion: The article entitled, "Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome" is available online at the bottom of the journal's website page at http://www.nejm.org)
"This is a real breakthrough in treatment of a devastating condition,'' said Dr. Michael Matthay at the University of California at San Francisco.
About 100,000 Americans suffer each year from the two conditions studied: acute lung injury and acute respiratory distress syndrome. The patients suffer from fluid and inflammation in their lungs - caused either by injury or infections like pneumonia - and cannot breathe properly. About 40 percent die.
In tests on 861 patients at 10 university medical centers, researchers found 40 percent died with the customary breaths, known as tidal volume. Only 31 percent died with breaths half the size - a 22 percent improvement.
The larger volumes were long thought necessary to push air into weak lungs. But doctors have increasingly worried about stretching and other damage caused by the big breaths. Some doctors have already begun using the smaller breaths.
Some patients suffer from complications, like cranial bleeding and sickle cell disease, that rule out the smaller air volume. Smaller breaths also tend to make patients short of breath and uncomfortable.
"It's not as natural, and patients don't tolerate it as well, so they have to be more heavily sedated,'' said Dr. Kenneth Davis, a surgeon at the University of Cincinnati. He said he believes lower air volumes will eventually be used with the vast majority of patients.
"It's better to be short of breath and stressed and survive than the alternative,'' he said.