A tidal volume of 7 mL/kg PBW or higher may be safe for COVID-19 patients

Purpose The 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/cmH(2)O. We investigated whether a tidal volume >= 7 ml/kg PBW may be safe in COVID-19 patients, particularly those with compliance >50 mL/cmH(2)O. Materials and methods This 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/cmH(2)O. Results 346 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. Conclusions A 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/cmH(2)O. This finding should be interpreted cautiously due to the retrospective study design. Trial registration: ClinicalTrails.gov NCT04388670.