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Ventilator-Induced Lung Injury
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To the Editor: Dr Ranieri and colleagues1 demonstrated that among patients affected by acute respiratory distress syndrome (ARDS), those receiving mechanical ventilation with conventional ventilation showed significantly higher levels of pulmonary and systemic mediators compared with patients who received ventilation with a "lung-protective" strategy. The authors concluded that "mechanical ventilation can induce a cytokine response that may be attenuated by a strategy to minimize overdistension and recruitment/derecruitment of the lung." The data suggest that ventilator-induced lung injury also can result in systemic inflammation and associated multiple organ failure.
However, I have several concerns about the study's methods. The authors reported that 7 patients dropped out; these patients were not included in the follow-up. Simply ignoring all patients that withdraw from a clinical trial will bias the results, usually in favor of the intervention. It should be standard practice to analyze the results of clinical trials on an intent-to-treat basis.2 The . . . [Full Text of this Article]
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Effect of Mechanical Ventilation on Inflammatory Mediators in Patients With Acute Respiratory Distress Syndrome: A Randomized Controlled Trial
V. Marco Ranieri, Peter M. Suter, Cosimo Tortorella, Renato De Tullio, Jean Michel Dayer, Antonio Brienza, Francesco Bruno, and Arthur S. Slutsky
JAMA. 1999;282(1):54-61.
ABSTRACT
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On the Physiologic and Clinical Relevance of Lung-borne Cytokines during Ventilator-induced Lung Injury
Dreyfuss et al.
Am. J. Respir. Crit. Care Med. 2003;167:1467-1471.
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