![]() 1998 - Amato et al publish as a small RCT suggests mortality benefit from low tidal volume ventilation.1996 - a large survey of intensivists’ ventilation practices for patients with ARDS showed most respondents reported using VTs >10 ml/ kg.1992 - Hickling introduces the concept of permissive hypercapnia.potential harms of high tidal volumes increasingly recognised in the 1970s and 1980s.early studies in ARDS patients described ventilation with a variety of VTs ranging from 10 to 24 mL/kg.for the next 50 years (!) anesthesiology textbooks continue to maintain that VT should be between 10–15 mL/kg for these benefits.showed that higher tidal volumes (VT) during anesthesia (18 patients undergoing laparotomy) resulted in less atelectasis, less acidosis, and improved oxygenation compared to lower VT.growing evidence of benefit in patients without ARDS, as all mechanically ventilated patients are at risk of VALI.clear evidence for benefit in ARDS in animals and humans.hypercapnia may also have directly beneficial effects in ARDS.biotrauma (release of inflammatory mediators).barotrauma (alveolar rupture and pneumothorax).volutrauma (hyperinflation and shearing injury).low tidal volume ventilation reduces ventilator-associated lung injury (VALI).Note: PBW in men is calculated as 50 (45 in women) + 0.91 (Height cm −152.4).6 mL/kg predicted body weight (not actual body weight) is most commonly quoted as this was the intervention arm of the practice defining ARDSNet ARMA trial and is physiologically normal for a healthy person.It is synonymous with low tidal volume ventilation (4-8 mL/kg) and often includes permissive hypercapnia Protective lung ventilation is the current standard of care for mechanical ventilation.
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