March 10, 2000
Researchers have found that altering the way they use mechanical ventilators to treat patients with acute lung injury and acute respiratory distress syndrome (ALI-ARDS) significantly reduces deaths from the disease. The study, which will be released early on the New England Journal of Medicine Web site on March 10, has profound implications for treating patients with the syndrome, the investigators say.
While an essential treatment for ALI-ARDS patients is to support their breathing on a ventilator, doctors have been concerned that the traditional large "tidal" volume, or breath sizes, from the ventilator can also damage the lungs. For this reason, a consortium of 10 medical centers set out to determine whether using smaller mechanical "breaths" would improve outcomes.
In the new study, they report that using the lower tidal volumes decreased the number of deaths by 22 percent. "By providing gentler breaths, we've given acutely inflamed and injured lungs a better chance of healing," says Roy Brower, M.D., study chair and associate professor of pulmonary medicine at Hopkins.
ALI-ARDS are caused by several different conditions, including pneumonia and other infections, and also by severe trauma. Patients with the syndrome accumulate abnormal amounts of fluid in the lungs and inflammation. This causes a poor gas exchange in the lungs and low levels of oxygen in the blood. Approximately 150,000 Americans suffer from ALI-ARDS annually and more than 40 percent of these die. The research was sponsored by the National Heart, Lung and Blood Institute.
To interview Brower, call Kate O'Rourke at 410-955-8665. The study will be posted on the NEJM site at http://www.nejm.org at 12 p.m. on March 10.