How did randomized trials impact mechanical ventilator setting in our unit?

Mechanical ventilation (MV) is the principle supportive care in ALI/ARDS patients. MV can be associated with several negative side effects and lung injury (VILI). In recent years several randomized trials tried to focus the optimal ventilatory strategy in ALI/ARDS patients aimed to avoid or minimize the VILI [1–3]. In this study we evaluated how MV has been employed in recent years in ALI/ARDS patients in our intensive care unit (eight beds). We retrospectively collected data of all ALI/ARDS patients, from 2001 to August 2004. To be included in the study the patient must to be ventilated for at least 48 hours without an unfavorable short-term prognosis. Sixty-two patients were enrolled; the mean age and the body mass index were not different between the years (54 ± 17, 62 ± 12, 56 ± 16 and 55 ± 20 years and 24 ± 3, 24 ± 2, 25 ± 6 and 25 ± 4 kg/m², respectively). The variables in Table 1 were not different at day 3 and day 7 between the four years. We did not find any difference in our 'local' lung ventilatory setting through the years regarding level of PEEP or tidal volume. Instead, to set the tidal volume based on body weight we prefer to set taking into account the airway plateau pressure.

Table 1