ICM Editor's Pick for January 

ICM Editor and Chair of the Editorial and Publications Committee Salvatore Maggiore chose to feature this interesting review as one of the "Articles of the Month" for January 2013: "Prophylactic protective ventilation: lower tidal volumes for all critically ill patients?

Authors François Lellouche and Jed Lipes submitted this additional summary noting the importance of their mechanical ventilation aptly named programme. 

Summary of Clinical Implications:

LOVE FOR ALL (Lower Tidal VolumeforALL) 

It is now well known that mechanical ventilation with high tidal volumes increases mortality in patients suffering from acute respiratory distress syndrome (ARDS). Recent data supports the generalisation of a prophylactic low tidal volume approach to almost all mechanically ventilated patients.

Barriers exist in implementing this strategy in ARDS patients, and it is likely that similar barriers exist for non-ARDS patients. Habitual practice patterns are challenging to modify and there is difficulty in acquiring an accurate predicted body weight (which requires the patient’s height and the use of a cumbersome formula). Consequently, a protective ventilation strategy is often under-utilised or applied incorrectly even in ARDS, and in particular short, obese and female patients are at high risk of being exposed to high tidal volumes.

Using bedside tools to facilitate the rapid and reliable determination of predicted body weight and the use of automated modes of ventilation are potential solutions to help implement protective ventilation, which we will be examining in our new research programme (LOVE FOR ALL). It is time to ventilate our patients’ lungs with a prophylactic protective ventilation strategy early after intubation to prevent rather than to treat ARDS.

PHOTO: Author François Lellouche

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