Limiting the tidal volume is one of the strategies of lung protection that help in reducing adverse events due to mechanical ventilation 4, 5. One of the most important aspects of ventilation management is minimizing pressure-related damage (barotrauma), capacity damage (volutrauma), and ventilator-induced lung injury (VILI) 2, 3, 4. Trial registration: UMIN-CTR (UMIN000041071).Īcute respiratory distress syndrome (ARDS) is a life-threatening condition due to respiratory failure, often requiring mechanical ventilation for survival 1. Our study indicated that ventilation with LTV was associated with reduced risk of mortality in patients with ARDS when compared with HTV. Subgroup-analysis by combined high positive end-expiratory pressure with LTV showed interaction (P = 0.01). When comparing LTV (4–8 ml/kg) versus HTV (> 8 ml/kg), the pooled risk ratio for 28-day mortality was 0.79 (11 studies, 95% confidence interval 0.66–0.94, I 2 = 43%, n = 1795, moderate certainty of evidence). Among the 19,864 records screened, 13 RCTs that recruited 1874 patients were included in our meta-analysis. We used the GRADE methodology to assess the certainty of evidence. The primary outcomes were 28-day mortality. Two authors independently evaluated the eligibility of studies and extracted the data. We included randomized controlled trials (RCTs) to compare the LTV strategy with the higher tidal volume ventilation (HTV) strategy in patients with ARDS. We performed a literature search on MEDLINE, CENTRAL, EMBASE, CINAHL, “Igaku-Chuo-Zasshi”, clinical trial registration sites, and the reference of recent guidelines. This systematic review and meta-analysis aimed to evaluate the use of LTV strategy in patients with ARDS. The effects of lower tidal volume ventilation (LTV) were controversial for patients with acute respiratory distress syndrome (ARDS).
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