Document Detail

A description of intraoperative ventilator management in patients with acute lung injury and the use of lung protective ventilation strategies.
MedLine Citation:
PMID:  21552117     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The incidence of acute lung injury (ALI) in hypoxic patients undergoing surgery is currently unknown. Previous studies have identified lung protective ventilation strategies that are beneficial in the treatment of ALI. The authors sought to determine the incidence and examine the use of lung protective ventilation strategies in patients receiving anesthetics with a known history of ALI.
METHODS: The ventilation parameters that were used in all patients were reviewed, with an average preoperative PaO₂/Fio₂ [corrected] ratio of ≤ 300 between January 1, 2005 and July 1, 2009. This dataset was then merged with a dataset of patients screened for ALI. The median tidal volume, positive end-expiratory pressure, peak inspiratory pressures, fraction inhaled oxygen, oxygen saturation, and tidal volumes were compared between groups.
RESULTS: A total of 1,286 patients met criteria for inclusion; 242 had a diagnosis of ALI preoperatively. Comparison of patients with ALI versus those without ALI found statistically yet clinically insignificant differences between the ventilation strategies between the groups in peak inspiratory pressures and positive end-expiratory pressure but no other category. The tidal volumes in cc/kg predicted body weight were approximately 8.7 in both groups. Peak inspiratory pressures were found to be 27.87 cm H₂O on average in the non-ALI group and 29.2 in the ALI group.
CONCLUSION: Similar ventilation strategies are used between patients with ALI and those without ALI. These findings suggest that anesthesiologists are not using lung protective ventilation strategies when ventilating patients with low PaO₂/Fio₂ [corrected] ratios and ALI, and instead are treating hypoxia and ALI with higher concentrations of oxygen and peak pressures.
James M Blum; Michael Maile; Pauline K Park; Michelle Morris; Elizabeth Jewell; Ronald Dechert; Andrew L Rosenberg
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Anesthesiology     Volume:  115     ISSN:  1528-1175     ISO Abbreviation:  Anesthesiology     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-06-23     Completed Date:  2011-08-23     Revised Date:  2012-04-25    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  75-82     Citation Subset:  AIM; IM    
Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan, USA.
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MeSH Terms
Acute Lung Injury / physiopathology*,  prevention & control*
Airway Management / methods*
Anoxia / etiology,  physiopathology
Carbon Dioxide / blood
Middle Aged
Oxygen / blood
Positive-Pressure Respiration
Respiration, Artificial / methods*
Respiratory Function Tests
Respiratory Mechanics
Tidal Volume / physiology
Reg. No./Substance:
124-38-9/Carbon Dioxide; 7782-44-7/Oxygen
Comment In:
Anesthesiology. 2012 Apr;116(4):965; author reply 965-6   [PMID:  22433207 ]
Erratum In:
Anesthesiology. 2012 Apr;116(4):967

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

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