Effect of a Low vs Intermediate Tidal Volume Strategy on Ventilator-Free Days in Intensive Care Unit Patients Without ARDS. The PReVENT Trial

Simonis et al. JAMA 2018. Published online October 24, 2018. doi:10.1001/jama.2018.14280

Clinical Question

• In mechanically ventilated patients without acute respiratory distress syndrome (ARDS), does a low tidal volume ventilation strategy (6mL/Kg), compared to intermediate tidal volume strategy (10mL/Kg), reduce the number of ventilator-free and alive days at day 28?

N = 961, 6 ICUs in Netherlands, randomised but not blinded

Authors’ Conclusions

• In this trial of adult patients in the ICU without ARDS who received invasive ventilation and were expected to not be extubated within 24 hours of randomization, a ventilation strategy using low tidal volume was not more effective than a strategy using intermediate tidal volume with respect to the number of ventilator-free days and alive at day 28

The Bottom Line

• Current practice aiming to avoid higher tidal volumes is based on previous ARDS and non ARDS trials which suggest higher volumes may cause harm
• In this study, no clear difference was found between lower vs higher tidal volumes strategies
• Therefore, clinicians will most likely continue with the current practice to target lower (6-8mL/Kg) tidal volumes in patients without ARDS until further evidence challenges this practice