A nationwide study has shown that mechanical ventilators should provide small, rather than large, breaths of air for patients with acute respiratory distress syndrome (ARDS).

The clinical trial found approximately 25 percent fewer deaths among ARDS patients when breathing machines gave small breaths compared to large breaths, which had been the standard. The trial was halted early after the first 800 patients when the treatment benefits were clearly demonstrated. The findings, published May 4 in The New England Journal of Medicine, offer some hope of improved care to thousands of patients across the world.

“There had been no successful specific treatments for the disease,” says Jonathan E. Gottlieb, MD, Associate Professor of Medicine at Jefferson Medical College, who led the university’s participation in the study. “Our approach had been to support the patients with ventilators while they healed on their own,” says Dr. Gottlieb, who is also Senior Vice President for Clinical Affairs at Thomas Jefferson University Hospital.

ARDS is an often fatal inflammatory condition that usually occurs in conjunction with conditions such as pneumonia, shock, sepsis and trauma. The disease can be confounding: otherwise healthy individuals who suffer burns or have been in an auto accident, for example, can suddenly develop symptoms. 

Approximately 150,000 Americans are affected each year and about 40 percent die. Because the patients have problems breathing on their own, mechanical ventilators supply oxygen-enriched air and take away carbon dioxide from the body. But treatments have been controversial. “It’s been hard to get a big-scale picture of the disease because people have only been able to do studies of treatments in small numbers at individual institutions, with conflicting results,” says Dr. Gottlieb. “The hypothesis for this trial was that ventilators might be harmful as well as helpful – that it might be beneficial not to overstretch the lungs of these patients. By not stretching the lung as much, we might allow it to heal.”

But there’s a downside: lower volumes of air might make the patients appear sicker. “Lower volumes might make them appear sicker for the first few days or weeks, but in the long run, by giving lungs some rest and a chance to heal, they would benefit and would be healthier,” Dr. Gottlieb says. “That’s what we found. But it was difficult to convince physicians that this was the best way to care for critically ill patients. 

“Patients in the high volume group often looked better but died earlier,” he says, adding that the new findings have changed the way ARDS patients are now typically treated.

The National Heart, Lung and Blood Institute’s ARDS Clinical Network, a consortium of 24 hospitals throughout the country, conducted the current trial, which was the first large-scale study to examine this treatment question. 

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