SynthesisIntensive care medicine2014
Association between tidal volume size, duration of ventilation, and sedation needs in patients without acute respiratory distress syndrome: an individual patient data meta-analysis.
Synthesis in Intensive care medicine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03909854 (Pragmatic Investigation of Volume Targeted Ventilation-1), which is not on this map. Cited by 60 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Pragmatic Investigation of Volume Targeted Ventilation-1 (PIVOT-1)
Who cites it
60 citing papers in PubMed, 1 synthesis or guideline pooled it.
- [S3 Guideline Sepsis-prevention, diagnosis, therapy, and aftercare : Long version].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2020Guideline
- Adaptive mechanical ventilation with automated minimization of mechanical power-a pilot randomized cross-over study.Critical care (London, England) · 2019Trial
- Trial
- Trial
- Bedside assessment of the effects of positive end-expiratory pressure on lung inflation and recruitment by the helium dilution technique and electrical impedance tomography.Intensive care medicine · 2016Trial
- Trial
- Comparison of limited driving pressure ventilation and low tidal volume strategies in adults with acute respiratory failure on mechanical ventilation: a randomized controlled trial.Therapeutic advances in respiratory diseaseTrial
- Association between tidal volume and mortality in patients without acute respiratory distress syndrome: A systematic review and meta-analysis.Biomedical reports · 2026Article
- Ventilation practices in acute brain injured patients and association with outcomes: the VENTIBRAIN multicenter observational study.Intensive care medicine · 2025Observational
- Effect of a low versus intermediate tidal volume strategy on pulmonary complications in patients at risk of acute respiratory distress syndrome-a randomized clinical trial.Frontiers in medicine · 2023Article
- Pulse oximetry for the diagnosis and management of acute respiratory distress syndrome.The Lancet. Respiratory medicine · 2022Review
- Intermediate tidal volume is an acceptable option for ventilated patients with acute respiratory distress syndrome.Medicina intensiva · 2022Article
- Intermediate tidal volume is an acceptable option for ventilated patients with acute respiratory distress syndrome.Medicina intensiva · 2022Article
- Excess Tidal Volume Ventilation in Critically Ill Adults Receiving Adaptive Pressure Control: A Cohort Study.Annals of the American Thoracic Society · 2022Article
- Low tidal volume ventilation is associated with mortality in COVID-19 patients-Insights from the PRoVENT-COVID study.Journal of critical care · 2022Observational
- Article
- Fat embolism syndrome.BJA education · 2021Review
- Multicentre observational study on practice of ventilation in brain injured patients: the VENTIBRAIN study protocol.BMJ open · 2021Article
- Implementing nudges to promote utilization of low tidal volume ventilation (INPUT): a stepped-wedge, hybrid type III trial of strategies to improve evidence-based mechanical ventilation management.Implementation science : IS · 2021Article
- Higher versus lower positive end-expiratory pressure in patients without acute respiratory distress syndrome: a meta-analysis of randomized controlled trials.Critical care (London, England) · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
19 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeMechanical ventilation with lower tidal volumes (≤6 ml/kg of predicted body weight, PBW) could benefit patients without acute respiratory distress syndrome (ARDS). However, tidal volume reduction could be associated with increased patient discomfort and sedation needs, and consequent longer duration of ventilation. The aim of this individual patient data meta-analysis was to assess the associations between tidal volume size, duration of mechanical ventilation, and sedation needs in patients without ARDS.
methodsStudies comparing ventilation with different tidal volume sizes in patients without ARDS were screened for inclusion. Corresponding authors were asked to provide individual participant data. Patients were assigned to three groups based on tidal volume size (≤6 ml/kg PBW, 6-10 ml/kg PBW, or ≥10 ml/kg PBW). Ventilator-free days, alive at day 28, and dose and duration of sedation (propofol and midazolam), analgesia (fentanyl and morphine), and neuromuscular blockade (NMB) were compared.
resultsSeven investigations (2,184 patients) were included in the analysis. The number of patients breathing without assistance by day 28 was higher in the group ventilated with tidal volume ≤6 ml/kg PBW compared to those ventilated with tidal volume ≥10 ml/kg PBW (93.1 vs. 88.6%; p = 0.027, respectively). Only two investigations (187 patients) could be included in the meta-analysis of sedation needs. There were neither differences in the percentage of study days that patients received sedatives, opioids, or NMBA nor in the total dose of benzodiazepines, propofol, opioids, and NMBA.
conclusionsThis meta-analysis suggests that use of lower tidal volumes in patients without ARDS at the onset of mechanical ventilation could be associated with shorter duration of ventilation. Use of lower tidal volumes seems not to affect sedation or analgesia needs, but this must be confirmed in a robust, well-powered randomized controlled trial.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.