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Contemporary Ventilator Management in Patients with and at risk of ALI/ARDS.
MedLine Citation:
PMID:  22906363     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: Ventilator practices in patients at risk for acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) are unclear. We examined factors associated with choice of set tidal volumes, and whether tidal volumes <8 mL/kg predicted body weight (PBW) relate to the development of ALI/ARDS. MATERIALS AND METHODS: We performed a secondary analysis of a multicenter cohort of adult patients at risk of lung injury with and without ALI/ARDS at onset of invasive ventilation. Descriptive statistics were used to describe ventilator practices in specific settings and ALI/ARDS risk groups. Logistic regression analysis was used to determine the factors associated with the use of tidal volumes <8 mL/kg PBW and the relationship of tidal volumes to ALI/ARDS development and outcome. RESULTS: Of 829 mechanically ventilated patients, 107 met criteria for ALI/ARDS at time of intubation and 161 developed ALI/ARDS after intubation (postintubation ALI/ARDS). There was significant intercenter variability in initial ventilator settings, and in the incidence of ALI/ARDS and post-intubation ALI/ARDS. The median tidal volume (VT) was 7.96 mL/kg PBW (IQR 7.14 - 8.94) in ALI/ARDS patients, and 8.45 mL/kg PBW (IQR 7.50 - 9.55) in patients without ALI/ARDS (p = 0.004). VT decreased from 8.40 mL/kg PBW (IQR 7.38 - 9.37) to 7.97 mL/kg PBW (IQR 6.90 - 9.23), (p < 0.0001) in those developing post-intubation ALI/ARDS. Among patients without ALI/ARDS, V g T >8mL/kg PBW was associated with shorter height and higher body mass index (BMI), while patients with pneumonia were less likely to get >62;8mL/kg PBW. Initial VT = or >8 mL/kg PBW was not associated with the post-intubation ALI/ARDS (ORadj 1.30; 95% CI 0.74 - 2.29) or worse outcomes. Post-intubation ALI/ARDS patien similar mortality as patients intubated with ALI/A ts had RDS. CONCLUSION: Clinicians seem to respond to ALI/ARDS with lower initial VT. Initial VT, however, was not associated with the development of post-intubation ALI/ARDS or other outcomes.
Authors:
Steven Y Chang; Ousama Dabbagh; Ognen Gajic; Amee Patrawalla; Marie-Carmelle Elie; Daniel Talmor; Atul Malhotra; Adebola Adesanya; Harry L Anderson 3rd; James M Blum; Pauline K Park; Michelle Ng Gong
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-16
Journal Detail:
Title:  Respiratory care     Volume:  -     ISSN:  0020-1324     ISO Abbreviation:  Respir Care     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7510357     Medline TA:  Respir Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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