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Table 2 Study results

From: Lower tidal volume at initiation of mechanical ventilation may reduce progression to acute respiratory distress syndrome: a systematic review

Randomized controlled trial

Author, year

Time of ARDS onset

Incidence of ARDS

Experimental ARDS rate

Control ARDS rate

OR

p

Commentsa

Determann, 2010

1.9 days

8% (n =12)

2.6% (n = 2)

13.5% (n = 10)

5.1 (1.2-22.6)

0.01

Trial stopped early for safety, due to ARDS in control.

Observational studies

Cohort studies

Author, year

Time of ARDS onset

Incidence of ARDS

VT ARDS Group

VT No-ARDS Group

OR b

p

Comments

Gajic, 2004

2.5 days

24% (n = 80)

Unknown

Unknown

1.29 (1.12-1.51)

<0.001

Proportion of ARDS increased as VT increased.

Gajic, 2005

Unknown

6.2% (n = 205)

670 ml ± 220c

620 ml ±110 c

1.26 (1.12-1.40)

<0.001

Proportion of ARDS increased as VT increased.

Kahn, 2006

3 days

27% (n = 170)

9.1 ml/kg PBW ±1.8

9.4 ml/kg PBW ±1.5

NS

0.06

ARDS development associated with transfusion, SAH severity, and PRBC transfusion.

Mascia, 2007

2.8 days

22% (n =18)

10.4 ml/kg PBW ± 1.1b

9.5 ml/kg PBW ±1.0c

5.54 (1.54-9.24)

0.008

Proportion of ARDS increased as VT increased.

Yilmaz, 2007â•‘

Unknown

28% (n = 60) before protocol; 10% (n = 17) after protocol

Unknown

Unknown

1.31 (1.16-1.50)

<0.001

Proportion of ARDS increased as VT increased.

Plurad, 2007

Unknown

8.2% (n = 192)

8.6 ml/kg PBW ± 1.7

8.8 ml/kg PBW ± 2.3

NS

0.383

ARDS associated with fluid balance and PRBC transfusion

Iscimen, 2008

5 hours

44% (n = 71)

6.9 ml/kg PBW (6.1-7.8)

7.0 ml/kg PBW (6.5-7.9)

NS

0.362

Delayed antibiotics and resuscitation associated with ARDS

Jia, 2008

3.3 days

19% (n = 152)

650.5 ml ± 119.7c

616.9 ml ± 112.8c

1.33 (1.09-1.62)

0.006

Proportion of ARDS increased as VT increased. Transfusion, fluid balance, airway pressures also associated with ARDS. Mean VT in patients that developed ARDS, 623.5 ml

Pasero, 2008

3.7 days

7% (n = 14)

Unknown

Unknown

2.04 (1.03-4.05)

0.042

Time of surgery and PEEP also associated with ARDS

Hughes, 2010

Unknown

28% (n = 25)

9.0 ml/kg PBW (8.3-10.0)

9.3 ml/kg PBW (8.3-10.1)

1.0 (0.3-3.2)

0.97

Intraoperative fluid >20 ml/kg/h associated with ARDS

Blum, 2011

Unknown

0.2% (n = 102)

9.2 ml/kg PBWc

9.1 ml/kg PBWc

0.77 (0.62-0.95)

0.02

PRBC transfusion strongest predictor of ARDS

Case-control study

Author, year

Time of ARDS onset

Incidence of ARDS

VT ARDS Group

VT No-ARDS Group

OR d

p

Comments

Fernandez-Perez, 2009

Unknown

1.9% (n = 83)

8.9 ml/kg PBW ±1.6

8.7 ml/kg PBW ±1.7

1.03 (0.84-1.26)

0.801

Time of surgery, transfusion, and fluid balance associated with ARDS

  1. ARDS, acute respiratory distress syndrome; NS, nonsignificant odds ratio (exact value and confidence interval not reported in original manuscript); OR, odds ratio; PEEP, positive end-expiratory pressure; PRBC, packed red blood cell; SAH, subarachnoid hemorrhage; VT, tidal volume. aEach trial attempted to control for various factors associated with development with ARDS, either with statistical analysis or trial design (for the RCT). bOR for risk of ARDS as a function of tidal volume. cStatistically significant differences existed in VT between groups. dAdjusted OR for VT between ARDS cases and matched controls. eProtocol aimed at VT and transfusion reduction. VT 10.6 ml/kg PBW (9.0-12.1) before protocol versus 7.7 ml/kg PBW (6.7-9.0).