Document Detail


Clinicians' approaches to mechanical ventilation in acute lung injury and ARDS.
MedLine Citation:
PMID:  11713144     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY OBJECTIVES: To examine clinicians' approaches to mechanical ventilation in patients with acute lung injury (ALI; PaO(2)/fraction of inspired oxygen [FIO(2)] <or= 300) and compare ventilator settings in patients with ARDS (PaO(2)/FIO(2) <or= 200) to settings in patients with milder oxygenation impairment (PaO(2)/FIO(2) of 201 to 300). DESIGN: Retrospective analysis of baseline data from prospective randomized trials conducted by the National Institutes of Health ARDS Network between 1996 and 1999. SETTING: Ten clinical centers comprising 24 hospitals and 74 medical and surgical ICUs of the ARDS Network. MEASUREMENTS AND RESULTS: The most common mode of mechanical ventilation in both groups was volume-assist control (56%). Synchronized intermittent mandatory ventilation (SIMV) or SIMV with pressure support was used more often in patients with PaO(2)/FIO(2) of 201 to 300 than in patients with ARDS. The use of pressure-control ventilation was uncommon (10% overall), as was the use of permissive hypercapnia (6% of patients with ARDS and 3% of patients with PaO(2)/FIO(2) of 201 to 300). The mean +/- SD tidal volume was 10.3 +/- 2 mL/kg of predicted body weight or 8.6 +/- 2 mL/kg of measured weight for patients with ARDS, and was not significantly different for patients with PaO(2)/FIO(2) of 201 to 300. Plateau pressures (Pplats) were lower in the PaO(2)/FIO(2) of 201 to 300 group (27 +/- 7 vs 31 +/- 8 for the ARDS group; p = 0.0003) and were > 35 cm H(2)O in 26% of patients. Seventy-eight percent of patients with ARDS received <or= 10 cm H(2)O of positive end-expiratory pressure. CONCLUSIONS: Physicians in ARDS Network centers caring for patients early in the course of ALI/ARDS used volume-targeted ventilation and selected tidal volumes that resulted in Pplats generally < 35 cm H(2)O. The average tidal volume was similar for patients with ARDS vs those with milder oxygenation deficits.
Authors:
B T Thompson; D Hayden; M A Matthay; R Brower; P E Parsons
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Chest     Volume:  120     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  2001 Nov 
Date Detail:
Created Date:  2001-11-19     Completed Date:  2001-12-13     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1622-7     Citation Subset:  AIM; IM    
Affiliation:
Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. tthompson1@partners.org
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MeSH Terms
Descriptor/Qualifier:
Airway Resistance
Carbon Dioxide / blood
Humans
Hydrogen-Ion Concentration
Lung Compliance
Multicenter Studies as Topic
Oxygen / blood
Positive-Pressure Respiration
Randomized Controlled Trials as Topic
Respiration, Artificial / methods*,  utilization
Respiratory Distress Syndrome, Adult / blood,  physiopathology,  therapy*
Tidal Volume
Grant Support
ID/Acronym/Agency:
N01-HR 46054-64/HR/NHLBI NIH HHS
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide; 7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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