Journal article
Contemporary Ventilator Management in Patients With and at Risk of ALI/ARDS
Respiratory care, Vol.58(4), pp.578-588
04/2013
DOI: 10.4187/respcare.01755
PMCID: PMC3840036
PMID: 22906363
Abstract
Background: Ventilator practices in patients at risk for acute lung injury (ALI) and ARDS are unclear. We examined factors associated with choice of set tidal volumes (VT), and whether VT < 8 mL/kg predicted body weight (PBW) relates to the development of ALI/ARDS.
Methods: We performed a secondary analysis of a multicenter cohort of adult subjects 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 VT < 8 mL/kg PBW and the relationship of VT to ALI/ARDS development and outcome.
Results: Of 829 mechanically ventilated patients, 107 met the criteria for ALI/ARDS at time of intubation, and 161 developed ALI/ARDS after intubation (post-intubation 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 VT was 7.96 (IQR 7.14-8.94) mL/kg PBW in ALI/ARDS subjects, and 8.45 (IQR 7.50-9.55) mL/kg PBW in subjects without ALI/ARDS (P = .004). VT decreased from 8.40 (IQR 7.38-9.37) mL/kg PBW to 7.97 (IQR 6.90-9.23) mL/kg PBW (P < .001) in those developing post-intubation ALI/ARDS. Among subjects without ALI/ARDS, VT ≥ 8 mL/kg PBW was associated with shorter height and higher body mass index, while subjects with pneumonia were less likely to get ≥ 8 mL/kg PBW. Initial VT ≥ 8 mL/kg PBW was not associated with the post-intubation ALI/ARDS (adjusted odds ratio 1.30, 95% CI 0.74-2.29) or worse outcomes. Post-intubation ALI/ARDS subjects had mortality similar to subjects intubated with ALI/ARDS.
Conclusions: 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.
Details
- Title: Subtitle
- Contemporary Ventilator Management in Patients With and at Risk of ALI/ARDS
- Creators
- Steven Y Chang - Division of Pulmonary and Critical Care Medicine, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New JerseyOusama Dabbagh - Department of Internal Medicine, University of Missouri, Columbia, MissouriOgnen Gajic - Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MinnesotaAmee Patrawalla - Division of Pulmonary and Critical Care Medicine, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New JerseyMarie-Carmelle Elie - Department of Emergency Medicine, University of Florida, Gainesville, FloridaDaniel S Talmor - Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston MassachusettsAtul Malhotra - Divisions of Pulmonary and Critical Care and Sleep Medicine, Harvard Medical School, Brigham and Women�s Hospital, Boston MassachusettsAdebola Adesanya - Department of Anesthesiology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TexasHarry L Anderson - Trauma/Surgical Critical Care, St Joseph Mercy Hospital, Ann Arbor, MichiganJames M Blum - Department of Anesthesiology, University of Michigan, Ann Arbor, MichiganPauline K Park - Division of Acute Care Surgery, University of Michigan, Ann Arbor, MichiganMichelle Ng Gong - Division of Critical Care Medicine, Montefiore Medical Center, Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
- Resource Type
- Journal article
- Publication Details
- Respiratory care, Vol.58(4), pp.578-588
- DOI
- 10.4187/respcare.01755
- PMID
- 22906363
- PMCID
- PMC3840036
- ISSN
- 0020-1324
- eISSN
- 1943-3654
- Grant note
- K24 HL093218 || HL / National Heart, Lung, and Blood Institute : NHLBI R01 HL090897 || HL / National Heart, Lung, and Blood Institute : NHLBI
- Language
- English
- Date published
- 04/2013
- Academic Unit
- Anesthesia
- Record Identifier
- 9984013275402771
Metrics
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