Contemporary ventilator management in patients with and at risk of ALI/ARDS.

Creative Commons License

Chang S. Y., Dabbagh O., Gajic O., Patrawalla A., Elie M., Talmor D. S., ...More

Respiratory care, vol.58, pp.578-88, 2013 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 58
  • Publication Date: 2013
  • Doi Number: 10.4187/respcare.01755
  • Journal Name: Respiratory care
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.578-88
  • Keywords: acute lung injury, ARDS, mechanical ventilation, mortality, tidal volume, RESPIRATORY-DISTRESS-SYNDROME, ACUTE LUNG INJURY, END-EXPIRATORY PRESSURE, MECHANICAL VENTILATION, TIDAL VOLUMES, PROTECTIVE-VENTILATION, CLINICAL-TRIAL, STRATEGY, ARDS, MORTALITY
  • Akdeniz University Affiliated: No

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 (V-T), and whether V-T < 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 V-T < 8 mL/kg PBW and the relationship of V-T 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 V-T 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). V-T 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, V-T >= 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 V-T >= 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 V-T. Initial V-T, however, was not associated with the development of post-intubation ALI/ARDS or other outcomes. (ClinicalTrials.gov registration NCT00889772)