Évolution des pratiques ventilatoires chez les patients en SDRA lors de la participation à un essai clinique randomisé : l’expérience d’une unité de réanimation française

Abstract: Introduction: The French Express study compared two alveolar recruitment managements (maximal versus standard) in Acute Respiratory Distress Syndrome (ARDS) patients ventilated with 6ml/kg of ideal body weight (IBW). The objective of the present study was to assess in a single intensive care unit, the impact of Express study on the mechanical ventilation settings in non-included ARDS patients. Patients and methods: From 16 October 2002 to 14 January 2005 all consecutive eligible but non-included patients in Express study were studied. The maximal and minimal tidal volumes, and the minimal and maximal respiratory rates were retrospectively recorded. These parameters were compared according to the date of patient''s admission and then the patients were separated in four quartiles (14, 15, 15, 15 patients). Results: From the first to the last study period separated by 26 months, the mean maximal tidal volume decreased from 9.0±1.3 to 7.4±1.0ml/kg of IBW (p =0.03), the proportion of patients ventilated with a maximal tidal volume greater than 8ml/kg decreased from 93% to 20% (p <0.01), the median minimal respiratory rate increased from 14 to 18 b/min (p =0.03) and the proportion of patients with a respiratory rate less than 20 b/min decreased from 100% to 73% (p <0.01). There were correlations between the time of patient''s admission and the maximal tidal volume (r =−0.43, p <0.01), the minimal tidal volume (r =−0.28, p <0.04) and the minimal respiratory rate (r =0.33, p <0.02). Conclusion: The participation in Express study led physicians to modify their mechanical ventilation settings. The maximal tidal volume decreased and the minimal respiratory rate increased in the ARDS eligible but non-included patients. [Copyright &y& Elsevier]