A nationwide clinical trial has found that a simple adjustment in the way patients receive breathing assistance can cut mortality by 22 percent among victims of Acute Respiratory Distress Syndrome (ARDS), an often fatal lung condition that affects between 100,000 and 150,000 people in the US annually.
Results of the 861-patient study will be published in May in the new England Journal of Medicine, but strong interest in the findings have prompted the journal to release the findings on their web site at noon, Friday, March 10, 2000. The web site is: www.nejm.org and the article is entitled "A Comparison of Ventilation with Traditional Tidal Volumes and Lower Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome."
Last year, the NIH-funded study was stopped ahead of schedule to alert critical care specialists of the life-saving results, and news of preliminary findings circulated at that time. The news released on the NEJM website Friday reports the study's final results, which will also appear later in the journal.
"This is a real breakthrough in treatment of a devastating condition," said Michael Matthay, MD, a principal investigator in the ten-city study and professor of medicine and anesthesia at UC San Francisco. "More patients die each year from ARDS than from breast cancer, and to be able to save some 20,000 lives with this change in the ventilators is very gratifying."
ARDS patients, usually already hospitalized for other conditions, become severely short of breath, needing intensive care, usually with a mechanical ventilator. Excess fluid in the lungs displaces oxygen and leads to respiratory failure, Matthay said. The oxygen-rich puffs of air provided to patients in the new technique are only about half the volume of those used in conventional ventilation therapy for ARDS. It had been thought that larger volumes would improve transfer of oxygen from the lungs to the blood. However, the results of this study indicate that the larger volumes worsen the degree of lung injury.
In addition to the UCSF Medical Center, the hospitals involved in the three-year study are affiliated with the Cleveland Clinic, Duke University, Johns Hopkins University, University of Colorado, University of Michigan, University of Pennsylvania, University of Utah, University of Washington and Vanderbilt University. The study was coordinated at Massachusetts General Hospital, Boston.
Journal
New England Journal of Medicine