• Alessandro Protti, Fabiana Madotto, Gaetano Florio, Tiziana Bove, Eleonora Carlesso, Giampaolo Casella, Francesca Dalla Corte, Giuseppe Foti, Riccardo Giudici, Thomas Langer, Carlo Montalto, Emanuele Rezoagli, Alessandro Santini, Pierpaolo Terragni, Alberto Zanella, Giacomo Grasselli, and Maurizio Cecconi.
• Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
• J Crit Care. 2024 Sep 25; 85: 154921154921.

PurposeThe novel coronavirus disease (COVID-19) has revived the debate on the optimal tidal volume during acute respiratory distress syndrome (ARDS). Some experts recommend 6 mL/kg of predicted body weight (PBW) for all patients, while others suggest 7-9 mL/kg PBW for those with compliance >50 mL/cmH2O. We investigated whether a tidal volume ≥ 7 ml/kg PBW may be safe in COVID-19 patients, particularly those with compliance >50 mL/cmH2O.Materials And MethodsThis secondary analysis of a multicenter study compares the Intensive Care Unit (ICU) mortality among 600 patients ventilated with <7 or ≥ 7 mL/kg PBW. Compliance was categorized as <40, 40-50, or > 50 mL/cmH2O.Results346 patients were ventilated with <7 (6.2 ± 0.5) mL/kg PBW and 254 with ≥7 (7.9 ± 0.9) mL/kg PBW. ICU mortality was 33 % and 29 % in the two groups (p = 0.272). At multivariable regression analysis, tidal volume ≥ 7 mL/kg PBW was associated with lower ICU mortality in the overall population (odds ratio: 0.62 [95 %-confidence interval: 0.40-0.95]) and in each compliance category.ConclusionsA tidal volume ≥ 7 (up to 9) mL/kg PBW was associated with lower ICU mortality in these COVID-19 patients, including those with compliance <40 mL/cmH2O. This finding should be interpreted cautiously due to the retrospective study design.Trial RegistrationClinicalTrails.govNCT04388670.Copyright © 2024. Published by Elsevier Inc.

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