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Intrinsic positive end-expiratory pressure in Acute Respiratory Distress Syndrome (ARDS) Network subjects

Hough, Catherine Lee MD, MSc; Kallet, Richard H. MS; Ranieri, V Marco MD; Rubenfeld, Gordon D. MD; Luce, John M. MD; Hudson, Leonard D. MD

doi: 10.1097/01.CCM.0000155782.86244.42
Clinical Investigations
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Objective: We tested the hypothesis that subjects randomized to the 6 mL/kg predicted body weight tidal volume study group of the National Institutes of Health Acute Respiratory Distress Syndrome (ARDS) Network study had higher levels of intrinsic positive end-expiratory pressure (PEEP) than subjects randomized to the 12 mL/kg predicted body weight tidal volume study group.

Design: Secondary analysis of a subgroup from a randomized controlled trial.

Setting: Hospitals located in San Francisco, CA, and Seattle, WA.

Patients: Eighty-four patients enrolled in the ARDS Network tidal volume trial in San Francisco, CA, and Seattle, WA, with records of measurement of intrinsic PEEP.

Interventions: None.

Measurements and Main Results: Intrinsic PEEP was assessed a median of six times over the first 48 hrs of ARDS Network protocol ventilation in study subjects, with no significant difference in number of measurements between subjects randomized to the tidal volume protocol of 6 mL/kg compared with 12 mL/kg. We found that intrinsic PEEP was higher among subjects randomized to the 6 mL/kg protocol, with a median intrinsic PEEP of 1.3 cm H2O (interquartile range, 0–3.1 cm H2O), compared with a median intrinsic PEEP of 0.5 cm H2O (interquartile range, 0–1.5 cm H2O) among subjects randomized to 12 mL/kg (p = .029). There was no difference in total PEEP between the study groups.

Conclusions: In a subgroup of ARDS Network subjects, intrinsic PEEP was statistically significantly higher in subjects randomized to the 6 mL/kg protocol than those in the 12 mL/kg study group. The amount of intrinsic PEEP was very low in both study groups, and difference of median intrinsic PEEP between the groups was <1 cm H2O. It is unlikely that the difference in intrinsic PEEP between the study groups was clinically important in the ARDS Network study of low tidal volume ventilation.

From the Division of Pulmonary and Critical Care Medicine, Department of Medicine at the University of Washington, Seattle, WA (CLH, GDR, LDH); Respiratory Care Services, San Francisco General Hospital, San Francisco, CA (RHK, JML) for the NHLBI ARDS Network (RHK, JML, LDH); and Universita di Torino, Dipartimento di discipline Medico-Chirurgiche, Sezione di Antestesio e Rianimazione, Ospedale S. Giovanni Battista, Italia (VMR).

Supported, in part by grants N01 HR46055 and P50 HL30452 HL07287 from the National Institutes of Health.

© 2005 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins