Ultra-low tidal volume ventilation for lung protection: not so fast

Since 2000, following the publication of the ARMA study, 1 Brower RG Matthay MA Morris A Schoenfeld D Thompson BT Wheeler A Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000; 342: 1301-1308 Crossref PubMed Scopus (10333) Google Scholar low tidal volume (VT) ventilation (LTV) has been the standard of care for patients with acute respiratory distress syndrome (ARDS). LTV often refers to ventilation with VT of 6·0 mL/kg predicted bodyweight, based on what was compared in the landmark ARMA study (ventilation with VT of 6·0 mL/kg vs 12·0 mL/kg predicted bodyweight resulting in a mortality rate of 31% vs 40%). Several—mostly observational—studies have since confirmed the benefits of ventilation with VT of 6·0 mL/kg predicted bodyweight, including in invasively ventilated patients with COVID-19. 2 Botta M Tsonas AM Pillay J et al. Ventilation management and clinical outcomes in invasively ventilated patients with COVID-19 (PRoVENT-COVID): a national, multicentre, observational cohort study. Lancet Respir Med. 2021; 9: 139-148 Summary Full Text Full Text PDF PubMed Scopus (150) Google Scholar Ultra-low tidal volume ventilation for COVID-19-related ARDS in France (VT4COVID): a multicentre, open-label, parallel-group, randomised trialIn patients with moderate-to-severe COVID-19-related ARDS, there was no significant difference with ULTV compared with LTV in the composite score based on mortality and ventilator-free days among patients alive at day 60. These findings do not support the systematic use of ULTV in patients with COVID-19-related ARDS. Full-Text PDF