Journal article
Mechanical Ventilation Practices and Low Tidal Volume Ventilation in Air Medical Transport Patients: The AIR-VENT Study
Respiratory care, Vol.67(6), pp.647-656
06/2022
DOI: 10.4187/respcare.09824
PMCID: PMC9994187
PMID: 35440496
Abstract
The management of mechanical ventilation critically impacts outcome for patients with acute respiratory failure. Ventilator settings in the early post-intubation period may be especially influential on outcome. Low tidal volume ventilation in the prehospital setting has been shown to impact the provision of low tidal volume after admission and influence outcome. However, there is an overall paucity of data on mechanical ventilation for air medical transport patients. The objectives of this study were to characterize air medical transport ventilation practices and assess variables associated with nonprotective ventilation.
This was a multi-center, nationwide (approximately 130 bases) retrospective cohort study conducted on consecutive, adult mechanically ventilated air medical transport patients treated in the prehospital environment. Descriptive statistics were used to assess the cohort; the chi-square test compared categorical variables, and continuous variables were compared using independent samples
test or Mann-Whitney U test. To assess for predictors of nonprotective ventilation, a multivariable logistic regression model was constructed to adjust for potentially confounding variables. Low tidal volume ventilation was defined as a tidal volume of ≤ 8 mL/kg predicted body weight (PBW).
A total of 68,365 subjects were studied. Height was documented in only 4,186 (6.1%) subjects. Significantly higher tidal volume/PBW (8.6 [8.3-9.2] mL vs 6.5 [6.1-7.0] mL) and plateau pressure (20.0 [16.5-25.0] cm H
O vs 18.0 [15.0-22.0] cm H
O) were seen in the nonpro-tective ventilation group
< .001 for both). According to sex, females received higher tidal volume/PBW compared to males (7.4 [6.6-8.0] mL vs 6.4 [6.0-6.8] mL,
< .001) and composed 75% of those subjects with nonprotective ventilation compared to 25% male,
< .001. After multivariable logistic regression, female sex was an independent predictor of nonprotective ventilation (adjusted odds ratio 6.79 [95% CI 5.47-8.43],
< .001).
The overwhelming majority of air medical transport subjects had tidal volume set empirically, which may be exposing patients to nonprotective ventilator settings. Given a lack of PBW assessments, the frequency of low tidal volume use remains unknown. Performance improvement initiatives aimed at indexing tidal volume to PBW are easy targets to improve the delivery of mechanical ventilation in the prehospital arena, especially for females.
Details
- Title: Subtitle
- Mechanical Ventilation Practices and Low Tidal Volume Ventilation in Air Medical Transport Patients: The AIR-VENT Study
- Creators
- Hawnwan P Moy - Washington University in St. LouisB Daniel Nayman - emsCharts at ZOLL Data Systems, Raleigh, North Carolina.David Olvera - University of Colorado DenverKarlee De Monnin - Washington University in St. LouisRyan D Pappal - Washington University in St. LouisJane M Hayes - Washington University in St. LouisNicholas M Mohr - University of IowaMarin H Kollef - Washington University in St. LouisChristopher M Palmer - Washington University in St. LouisEnyo Ablordeppey - Washington University in St. LouisBrian W Roberts - Cooper University HospitalBrian M Fuller - Washington University in St. Louis
- Resource Type
- Journal article
- Publication Details
- Respiratory care, Vol.67(6), pp.647-656
- DOI
- 10.4187/respcare.09824
- PMID
- 35440496
- PMCID
- PMC9994187
- NLM abbreviation
- Respir Care
- ISSN
- 0020-1324
- eISSN
- 1943-3654
- Language
- English
- Date published
- 06/2022
- Academic Unit
- Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center
- Record Identifier
- 9984296140902771
Metrics
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