{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T14:05:57Z","timestamp":1791295557261,"version":"4.1.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2015,1,1]],"date-time":"2015-01-01T00:00:00Z","timestamp":1420070400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,1,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Reducing tidal volume decreases mortality in acute respiratory distress syndrome (ARDS). However, the effect of the timing of low tidal volume ventilation is not well understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the association of intensive care unit (ICU) mortality with initial tidal volume and with tidal volume change over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Multivariable, time-varying Cox regression analysis of a multisite, prospective study of 482 patients with ARDS with 11,558 twice-daily tidal volume assessments (evaluated in milliliter per kilogram of predicted body weight [PBW]) and daily assessment of other mortality predictors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>An increase of 1 ml\/kg PBW in initial tidal volume was associated with a 23% increase in ICU mortality risk (adjusted hazard ratio, 1.23; 95% confidence interval [CI], 1.06\u20131.44; P\u2009=\u20090.008). Moreover, a 1 ml\/kg PBW increase in subsequent tidal volumes compared with the initial tidal volume was associated with a 15% increase in mortality risk (adjusted hazard ratio, 1.15; 95% CI, 1.02\u20131.29; P\u2009=\u20090.019). Compared with a prototypical patient receiving 8 days with a tidal volume of 6 ml\/kg PBW, the absolute increase in ICU mortality (95% CI) of receiving 10 and 8 ml\/kg PBW, respectively, across all 8 days was 7.2% (3.0\u201313.0%) and 2.7% (1.2\u20134.6%). In scenarios with variation in tidal volume over the 8-day period, mortality was higher when a larger volume was used earlier.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Higher tidal volumes shortly after ARDS onset were associated with a greater risk of ICU mortality compared with subsequent tidal volumes. Timely recognition of ARDS and adherence to low tidal volume ventilation is important for reducing mortality.<\/jats:p>\n                    <jats:p>Clinical trial registered with www.clinicaltrials.gov (NCT 00300248).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.201409-1598oc","type":"journal-article","created":{"date-parts":[[2014,12,5]],"date-time":"2014-12-05T17:52:46Z","timestamp":1417801966000},"page":"177-185","source":"Crossref","is-referenced-by-count":210,"title":["Timing of Low Tidal Volume Ventilation and Intensive Care Unit Mortality in Acute Respiratory Distress Syndrome. A Prospective Cohort Study"],"prefix":"10.1093","volume":"191","author":[{"given":"Dale M.","family":"Needham","sequence":"first","affiliation":[{"name":"Outcomes After Critical Illness and Surgery Group"},{"name":"Division of Pulmonary and Critical Care Medicine, School of Medicine"},{"name":"Department of Physical Medicine and Rehabilitation, School of Medicine"},{"name":"Armstrong Institute for Patient Safety and Quality"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Yang","sequence":"additional","affiliation":[{"name":"Armstrong Institute for Patient Safety and Quality"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor D.","family":"Dinglas","sequence":"additional","affiliation":[{"name":"Outcomes After Critical Illness and Surgery Group"},{"name":"Division of Pulmonary and Critical Care Medicine, School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro A.","family":"Mendez-Tellez","sequence":"additional","affiliation":[{"name":"Outcomes After Critical Illness and Surgery Group"},{"name":"Department of Anesthesiology and Critical Care Medicine, School of Medicine, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl","family":"Shanholtz","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, University of Maryland, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan E.","family":"Sevransky","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy and Critical Care, Emory University School of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy G.","family":"Brower","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter 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