Low Tidal Volume Ventilation Facts

Did You Know?

Low tidal volume ventilation (LTVV) is one of the interventions specifically designed to prevent ventilator-associated conditions (VAC). 

For patients without acute respiratory distress syndrome (ARDS), target the recommended tidal volume of 6–8 mL/kg predicted body weight (PBW).

For patients with ARDS, the recommended tidal volume target is between 4–6 mL/kg PBW.

Emerging evidence links protective tidal ventilation to decreased incidence of acute lung injury (ALI) and ARDS, as well as decreased time on the ventilator.

Use at least 5 cm H2O positive end expiratory pressure (PEEP).

Why wait? Initiate LTVV on all patients to prevent ALI and ARDS. Prevent the lung damage that can occur within a few hours of mechanical ventilation at high tidal volume.

What the Evidence Says

• Low tidal volume ventilation could shorten the duration of mechanical ventilation in general; LTVV may therefore be an effective strategy to lower ventilator-associated events rates.¹
• In patients with healthy lungs, low tidal volume ventilation, moderate PEEP, and repeated recruitment maneuvers can markedly help improve postoperative outcome in patients undergoing abdominal surgery.²
• Low tidal volume ventilation can benefit patients with or without ARDS.³
• Low tidal volume can reduce ARDS progression in patients without ARDS.⁴
• Mechanical ventilation with higher tidal volumes contributes to the development of lung injury in patients without ALI at the onset of mechanical ventilation.⁵
• Ventilation with low tidal volumes is associated with a lower risk of development of pulmonary complications in patients without ARDS.⁶
• Strong consideration should be given to limiting large tidal volume, not only in patients with established acute lung injury but also in patients at risk for ALI.⁷
• The prophylactic protective ventilation strategy can be recommended for almost all mechanically ventilated patients who do not yet have ARDS and particularly those with risk factors to prevent progressive development of lung injury.⁸
• The use of lower tidal volume should be considered in all mechanically ventilated patients regardless of ALI.⁹

References

1. Klompas M, Branson R, Eichenwald EC, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35(8):915-36. PMID: 25026607.
2. Futier E, Godet T, Millot A, et al. Mechanical ventilation in abdominal surgery. Ann Fr Anesth Reanim 2014;33(7-8):472-5. PMID: 25153670.
3. Kilickaya O, Gajic O. Initial ventilator settings for critically ill patients. Crit Care 2013;17(2):123. PMID: 23510269.
4. Fuller BM, Mohr NM, Drewry AM, et al. Lower tidal volume at initiation of mechanical ventilation may reduce progression to acute respiratory distress syndrome: A systematic review. Crit Care 2013;17(1):R11. PMID: 23331507.
5. Determann RM, Royakkers A, Wolthuis EK, et al. Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial. Crit Care 2010;14(1):R1. PMID: 20055989.
6. Neto AS, Simonis FD, Barbas CS, et al. Lung-protective ventilation with low tidal volumes and the occurrence of pulmonary complications in patients without acute respiratory distress syndrome: a systematic review and individual patient data analysis. Crit Care Med 2015;43(10):2155-63. PMID: 26181219.
7. Gajic O, Dara SI, Mendez JL, et al. Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation. Crit Care Med 2004;32(9):1817-24. PMID: 15343007.
8. Lellouche F, Lipes J. Prophylactic protective ventilation: lower tidal volumes for all critically ill patients? Intensive Care Med 2013;39(1):6-15. PMID: 23108608.
9. Schultz MJ, Haitsma JJ, Slutsky AS, et al. What tidal volumes should be used in patients without acute lung injury? Anesthesiology 2007;106(6):1226-31. PMID: 17525599.