Researchers conducted this randomized clinical trial to compare the effectiveness of a low tidal volume ventilation strategy vs an intermediate tidal volume strategy in patients admitted to the intensive care unit (ICU) without acute respiratory distress syndrome (ARDS). They found that low tidal volume strategy did not result in a greater number of ventilator-free days vs an intermediate tidal volume strategy in patients in the ICU without ARDS who were expected not to be extubated within 24 hours of randomization.

Methods

• This trial was conducted between September 1, 2014 and August 20, 2017, and included ICU patients without ARDS who were not expected to be extubated within 24 hours of ventilation from six ICUs in the Netherlands.
• Main intervention analyzed was invasive ventilation using low tidal volumes (n=477) or intermediate tidal volumes (n=484).
• The number of ventilator-free days and number of patients alive at day 28 was the primary outcome.
• Length of ICU and hospital stay; ICU, hospital, and 28- and 90-day mortality; and development of ARDS, pneumonia, severe atelectasis, or pneumothorax were the included secondary outcomes.

Results

• A total of 961 patients (65% male) were enrolled at a median age of 68 years.
• A total of 475 patients in the low tidal volume group had a median of 21 ventilator-free days, and 480 patients in the intermediate tidal volume group had a median of 21 ventilator-free days at day 28.
• No significant difference was evident among ICU (median, 6 vs 6 days) and hospital (median, 14 vs 15 days) length of stay or 28-day (34.9% vs 32.1%), and 90-day (39.1% vs 37.8%) mortality.
• No significant difference was observed in the percentage of patients who developed the following adverse events: ARDS (3.8% vs 5.0), pneumonia (4.2% vs 3.7%), severe atelectasis (11.4% vs 11.2%), and pneumothorax (1.8% vs 1.3%).