Contemporary ventilator management in patients with and at risk of ALI/ARDS
| Autor: | Steven Y, Chang, Ousama, Dabbagh, Ognen, Gajic, Amee, Patrawalla, Marie-Carmelle, Elie, Daniel S, Talmor, Atul, Malhotra, Adebola, Adesanya, Harry L, Anderson, James M, Blum, Pauline K, Park, Michelle Ng, Gong, Greg, Martin |
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| Rok vydání: | 2012 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male ARDS Pediatrics medicine.medical_specialty medicine.medical_treatment Health Status Acute Lung Injury Lung injury Critical Care and Intensive Care Medicine Article Body Mass Index Cohort Studies Risk Factors Tidal Volume Medicine Intubation Humans Practice Patterns Physicians' Tidal volume Aged Mechanical ventilation Respiratory Distress Syndrome business.industry Body Weight General Medicine Odds ratio respiratory system Length of Stay Middle Aged medicine.disease Respiration Artificial respiratory tract diseases Anesthesia Cohort Female business Body mass index |
| Zdroj: | Respiratory care. 58(4) |
| ISSN: | 1943-3654 |
| Popis: | See the complete list of Lung Injury Prevention Study Investigators members below. 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. (ClinicalTrials.gov registration [NCT00889772][1]) [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00889772&atom=%2Frespcare%2F58%2F4%2F578.atom |
| Databáze: | OpenAIRE |
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