Science review: Mechanisms of ventilator-induced injury

Table 1 Clinical studies of protective ventilation

Study	Intervention group	Control group	Outcome
Acute Respiratory Distress Syndrome Network low tidal volume (861 patients) [4]	V_T, 6.2 ± 0.8 ml/kg (PBW); PEEP, 9.4 ± 3.6 cmH₂O	V_T, 11.8 ± 0.8 ml/kg (PBW); PEEP, 8.6 ± 3.6 cmH₂O	Mortality reduced from 40% to 31% with low tidal volume, more ventilator-free days, more organ failure-free days
Amato et al. (53 patients) [62]	V_T, ~6 ml/kg; PEEP, 14.7 ± 3.9 cmH₂O (PEEP set by PVC)	V_T, ~12 ml/kg; PEEP, 8.7 ± 0.4 cmH₂O	Mortality reduced from 71% to 38% with intervention
Stewart et al. (120 patients) [66]	V_T, 7.0 ± 0.7 ml/kg; PEEP, 8.6 ± 3.0 cmH₂O	V_T, 10.7 ± 1.4 ml/kg; PEEP, 7.2 ± 3.3 cmH₂O	No difference
Brochard et al. (116 patients) [65]	V_T, 7.1 ± 1.3 ml/kg; PEEP, 10.7 ± 2.9 cmH₂O	V_T, 10.3 ± 1.7 ml/kg; PEEP, 10.7 ± 2.3 cmH₂O	No difference
Brower et al. (52 patients) [64]	V_T, 7.3 ± 0.7 ml/kg (PBW); PEEP, 8.3 ± 0.5 cmH₂O	V_T, 10.2 ± 0.7 ml/kg (PBW); PEEP, 9.5 ± 0.5 cmH₂O	No difference

V_T, tidal volume; PEEP, positive end expiratory pressure; PBW, predicted body weight (0.91 [height (cm) – 152.4] + 50 for males or 0.91[height (cm) – 152.4] + 45.5 for females – note that PBW is generally up to 20% lower than dry body weight [used in other studies]); PVC, pressure–volume curve of the respiratory system.

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