Clinical studies of mechanical ventilation with low tidal volume plus positive end-expiratory pressure for post-traumatic acute respiratory distress syndrome

Objective To study the effect of mechanical ventilation (MV) with low tidal volume (LTV) plus positive end-expiratory pressure (PEEP) in treatment of post-traumatic acute respiratory distress syndrome (ARDS). Methods From October 1997 to October 2003, 26 cases of post-traumatic ARDS were treated by conventional MV (Group A, n=11, from October 1997 to August 2000; VT: 12-15 ml/kg) and by MV associated with LTV plus PEEP (Group B, n=15,from September 2000 to October 2003; VT: 5-8 ml/kg). A comparison was made upon blood gas, hemodynamic indices, incidence of ventilation-induced lung injury (VILI), time and incidence of multiple organ dysfunction syndrome (MODS) as well as fatality of ARDS. Results There was no statistically significant difference in PaO 2 of blood gas and hemodynamic indices between both groups, while PaCO 2 in Group B was higher than that in Group A (P0.05). Furthermore, in Group B, the incidence of MODS and the fatality of ARDS were decreased, with no recurrence of VILI. Latent period for occurrence of MODS in Group B was longer than that in Group A (P0.05). Conclusions MV with LTV plus PEEP can attain the same effect of oxygen saturation as conventional MV. In the meantime, PEEP (5-18 cm H 2O) and slight hypercapnia is suitable for treatment of post-traumatic ARDS, for they have little influence on hemodynamics, can prevent recurrence of VILI and defer the occurrence of MODS.