Document Detail


Incidence, risk factors and outcome of barotrauma in mechanically ventilated patients.
MedLine Citation:
PMID:  14991090     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine the incidence, risk factors, and outcome of barotrauma in a cohort of mechanically ventilated patients where limited tidal volumes and airway pressures were used. DESIGN AND SETTING: Prospective cohort of 361 intensive care units from 20 countries. PATIENTS AND PARTICIPANTS: A total of 5183 patients mechanically ventilated for more than 12 h. MEASUREMENTS AND RESULTS: Baseline demographic data, primary indication for mechanical ventilation, daily ventilator settings, multiple-organ failure over the course of mechanical ventilation and outcome were collected. Barotrauma was present in 154 patients (2.9%). The incidence varied according to the reason for mechanical ventilation: 2.9% of patients with chronic obstructive pulmonary disease; 6.3% of patients with asthma; 10.0% of patients with chronic interstitial lung disease (ILD); 6.5% of patients with acute respiratory distress syndrome (ARDS); and 4.2% of patients with pneumonia. Patients with and without barotrauma did not differ in any ventilator parameter. Logistic regression analysis identified as factors independently associated with barotrauma: asthma [RR 2.58 (1.05-6.50)], ILD [RR 4.23 (95%CI 1.78-10.03)]; ARDS as primary reason for mechanical ventilation [RR 2.70 (95%CI 1.55-4.70)]; and ARDS as a complication during the course of mechanical ventilation [RR 2.53 (95%CI 1.40-4.57)]. Case-control analysis showed increased mortality in patients with barotrauma (51.4 vs 39.2%; p=0.04) and prolonged ICU stay. CONCLUSIONS: In a cohort of patients in whom airway pressures and tidal volume are limited, barotrauma is more likely in patients ventilated due to underlying lung disease (acute or chronic). Barotrauma was also associated with a significant increase in the ICU length of stay and mortality.
Authors:
Antonio Anzueto; Fernando Frutos-Vivar; Andres Esteban; Inmaculada Alía; Laurent Brochard; Thomas Stewart; Salvador Benito; Martin J Tobin; Jose Elizalde; Fernando Palizas; Cide M David; Jorge Pimentel; Marco González; Luis Soto; Gabriel D'Empaire; Paolo Pelosi
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2004-02-28
Journal Detail:
Title:  Intensive care medicine     Volume:  30     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2004 Apr 
Date Detail:
Created Date:  2004-03-31     Completed Date:  2004-10-21     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  612-9     Citation Subset:  IM    
Affiliation:
Department of Medicine, Division of Pulmonary /Critical Care Medicine, University of Texas Health Science Center and South Texas Veterans Health Care System, Audie L. Murphy Memorial Veterans Hospital Division, San Antonio, TX USA. anzueto@uthscsa.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Asthma / pathology,  therapy
Barotrauma / etiology*,  mortality,  therapy
Cohort Studies
Female
Humans
Incidence
Intensive Care Units
Lung / pathology*
Male
Middle Aged
Prognosis
Prospective Studies
Pulmonary Disease, Chronic Obstructive / pathology,  therapy
Respiration, Artificial / adverse effects*
Respiratory Distress Syndrome, Adult / pathology,  therapy
Risk Factors
Survival Rate
Comments/Corrections
Comment In:
Intensive Care Med. 2004 Apr;30(4):533-5   [PMID:  14985954 ]

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