Journal article
Excessive tidal volume from breath stacking during lung-protective ventilation for acute lung injury
Critical care medicine, Vol.36(11), pp.3019-3023
2008
DOI: 10.1097/CCM.0b013e31818b308b
PMID: 18824913
Abstract
Rationale: Low tidal volume ventilation strategies for patients with respiratory failure from acute lung injury may lead to breath stacking and higher volumes than intended.
Objective: To determine frequency, risk factors, and volume of stacked breaths during low tidal volume ventilation for acute lung injury.
Design, setting, and patients: Prospective cohort study of mechanically ventilated patients with acute lung injury (enrolled from August 2006 through May 2007) treated with low tidal volume ventilation in a medical intensive care unit at an academic tertiary care hospital.
Interventions: Patients were ventilated with low tidal volumes using the Acute Respiratory Distress Syndrome Network protocol for acute lung injury. Continuous flow-time and pressure-time waveforms were recorded. The frequency, risk factors, and volume of stacked breaths were determined. Sedation depth was monitored using Richmond agitation sedation scale.
Measurements and main results: Twenty patients were enrolled and studied for a mean 3.3 +/- 1.7 days. The median (interquartile range) Richmond agitation sedation scale was -4 (-5, -3). Inter-rater agreement for identifying stacked breaths was high (kappa 0.99, 95% confidence interval 0.98-0.99). Stacked breaths occurred at a mean 2.3 +/- 3.5 per minute and resulted in median volumes of 10.1 (8.8-10.7) mL/kg predicted body weight, which was 1.62 (1.44-1.82) times the set tidal volume. Stacked breaths were significantly less common with higher set tidal volumes (relative risk 0.4 for 1 mL/kg predicted body weight increase in tidal volume, 95% confidence interval 0.23-0.90).
Conclusion: Stacked breaths occur frequently in low tidal volume ventilation despite deep sedation and result in volumes substantially above the set tidal volume. Set tidal volume has a strong influence on frequency of stacked breaths.
Details
- Title: Subtitle
- Excessive tidal volume from breath stacking during lung-protective ventilation for acute lung injury
- Creators
- Mark C POHLMAN - Section of Pulmonary and Critical Care Medicine, Departments of Medicine, University of Chicago, Chicago, IL, United StatesKathryn E MCCALLISTER - Section of Pulmonary and Critical Care Medicine, Departments of Medicine, University of Chicago, Chicago, IL, United StatesWilliam D SCHWEICKERT - Section of Pulmonary and Critical Care Medicine, Department of Medicine (WDS), University of Pennsylvania, Philadelphia, PA, United StatesAnne S POHLMAN - Section of Pulmonary and Critical Care Medicine, Departments of Medicine, University of Chicago, Chicago, IL, United StatesCelerina P NIGOS - Section of Pulmonary and Critical Care Medicine, Departments of Medicine, University of Chicago, Chicago, IL, United StatesJerry A KRISHNAN - Department of HealthStudies, University of Chicago, Chicago, IL, United StatesJeff T CHARBENEAU - Department of HealthStudies, University of Chicago, Chicago, IL, United StatesBrian K GEHLBACH - Section of Pulmonary and Critical Care Medicine, Departments of Medicine, University of Chicago, Chicago, IL, United StatesJohn P KRESS - Section of Pulmonary and Critical Care Medicine, Departments of Medicine, University of Chicago, Chicago, IL, United StatesJesse B HALL - Section of Pulmonary and Critical Care Medicine, Departments of Medicine, University of Chicago, Chicago, IL, United States
- Resource Type
- Journal article
- Publication Details
- Critical care medicine, Vol.36(11), pp.3019-3023
- Publisher
- Lippincott; Hagerstown, MD
- DOI
- 10.1097/CCM.0b013e31818b308b
- PMID
- 18824913
- ISSN
- 0090-3493
- eISSN
- 1530-0293
- Language
- English
- Date published
- 2008
- Academic Unit
- Neurology; Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
- Record Identifier
- 9984020624402771
Metrics
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