Mechanical Ventilation Practices and Low Tidal Volume Ventilation in Air Medical Transport Patients: The AIR-VENT Study.
| Autor: | Moy HP; Department of Emergency Medicine, Division of Emergency Medical Services, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri., Nayman BD; emsCharts at ZOLL Data Systems, Raleigh, North Carolina., Olvera D; University of Colorado Denver, Denver, Colorado., Monnin K; Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri., Pappal RD; Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri., Hayes JM; Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri., Mohr NM; Departments of Emergency Medicine and Anesthesiology, Division of Critical Care, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa., Kollef MH; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri., Palmer CM; Departments of Anesthesiology and Emergency Medicine, Division of Critical Care, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri., Ablordeppey E; Departments of Anesthesiology and Emergency Medicine, Division of Critical Care, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri., Roberts BW; Department of Emergency Medicine, Cooper University Hospital, Camden, New Jersey., Fuller BM; Departments of Anesthesiology and Emergency Medicine, Division of Critical Care, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri. fullerb@wustl.edu. |
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| Jazyk: | angličtina |
| Zdroj: | Respiratory care [Respir Care] 2022 Jun; Vol. 67 (6), pp. 647-656. Date of Electronic Publication: 2022 Apr 19. |
| DOI: | 10.4187/respcare.09824 |
| Abstrakt: | Background: 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. Methods: 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 t 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). Results: 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 Conclusions: 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. Competing Interests: The authors have disclosed no conflicts of interest. (Copyright © 2022 by Daedalus Enterprises.) |
| Databáze: | MEDLINE |
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