Evaluation Of A New Tool To Measure Patient's Height During Mechanical Ventilation: Impact On Protective Ventilation Implementation

Bojmehrani, Azadeh; Bouchard, Pierre-Alexandre; Bouchard, Carmelle; L’Her, Erwan; Lellouche, François

doi:10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a1720

Cited by 3 publications

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“…Preliminary evaluation of this new method showed promising results, with very close correlation with the reference method. 38 In the present study, we did not test the reproducibility of the measurements with different investigators, and this will need to be performed in subsequent studies.…”

Section: Limitationsmentioning

confidence: 97%

Comparison of Usual and Alternative Methods to Measure Height in Mechanically Ventilated Patients: Potential Impact on Protective Ventilation

et al. 2013

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BACKGROUND: Protective ventilation implementation requires the calculation of predicted body weight (PBW), determined by a formula based on gender and height. Consequently, height inaccuracy may be a limiting factor to correctly set tidal volumes. The objective of this study was to evaluate the accuracy of different methods in measuring heights in mechanically ventilated patients. METHODS: Before cardiac surgery, actual height was measured with a height gauge while subjects were standing upright (reference method); the height was also estimated by alternative methods based on lower leg and forearm measurements. After cardiac surgery, upon ICU admission, a subject's height was visually estimated by a clinician and then measured with a tape measure while the subject was supine and undergoing mechanical ventilation. RESULTS: One hundred subjects (75 men, 25 women) were prospectively included. Mean PBW was 61.0 ؎ 9.7 kg, and mean actual weight was 30.3% higher. In comparison with the reference method, estimating the height visually and using the tape measure were less accurate than both lower leg and forearm measurements. Errors above 10% in calculating the PBW were present in 25 and 40 subjects when the tape measure or visual estimation of height was used in the formula, respectively. With lower leg and forearm measurements, 15 subjects had errors above 10% (P < .001). CONCLUSIONS: Our results demonstrate that significant variability exists between the different methods used to measure height in bedridden patients on mechanical ventilation. Alternative methods based on lower leg and forearm measurements are potentially interesting solutions to facilitate the accurate application of protective ventilation.

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Section: Limitationsmentioning

confidence: 97%

Comparison of Usual and Alternative Methods to Measure Height in Mechanically Ventilated Patients: Potential Impact on Protective Ventilation

et al. 2013

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“…Novel devices such as applications on smartphones, (e.g., iAnthropometer ICU), where one can quickly take a bedside picture of a patients leg and calculate the patients height based on validated formulas, and automatically derive the PBW and subsequent VTs, are promising tools ( Figure 1 ) [ 113 ]. This application was more accurate at calculating patient height than both the method of visual estimation and supine in-bed tape measurement [ 114 ].…”

Section: Challenges and Controversy To The Use Of Protective Ventimentioning

confidence: 99%

Low Tidal Volume Ventilation in Patients without Acute Respiratory Distress Syndrome: A Paradigm Shift in Mechanical Ventilation

Lipes

Bojmehrani

Lellouche

2012

Critical Care Research and Practice

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Protective ventilation with low tidal volume has been shown to reduce morbidity and mortality in patients suffering from acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Low tidal volume ventilation is associated with particular clinical challenges and is therefore often underutilized as a therapeutic option in clinical practice. Despite some potential difficulties, data have been published examining the application of protective ventilation in patients without lung injury. We will briefly review the physiologic rationale for low tidal volume ventilation and explore the current evidence for protective ventilation in patients without lung injury. In addition, we will explore some of the potential reasons for its underuse and provide strategies to overcome some of the associated clinical challenges.

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“…The ability to rapidly calculate PBW at the bedside is important. Novel devices such as applications on smartphones (e.g., iAnthropometer ICU), where one can quickly calculate the patients' height from the patient's lower leg length based on validated formulas and automatically derive the PBW and subsequent VTs are promising tools [84,85]. This application was more accurate at calculating patient height than both the method of visual estimation and supine in-bed tape measurement [85].…”

Section: Overcoming Barriers To Implement Strategies Of Tidal Volume ...mentioning

confidence: 99%

Prophylactic protective ventilation: lower tidal volumes for all critically ill patients?

Lellouche

Lipes

2012

Intensive Care Med

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High tidal volumes have historically been recommended for mechanically ventilated patients during general anesthesia. High tidal volumes have been shown to increase morbidity and mortality in patients suffering from acute respiratory distress syndrome (ARDS). Barriers exist in implementing a tidal volume reduction strategy related to the inherent difficulty in changing one's practice patterns, to the current need to individualize low tidal volume settings only for a specific subgroup of mechanically ventilated patients (i.e., ARDS patients), the difficulty in determining the predicated body weight (requiring the patient's height and a complex formula). Consequently, a protective ventilation strategy is often under-utilized as a therapeutic option, even in ARDS. Recent data supports the generalization of this strategy prophylactically to almost all mechanically ventilated patients beginning immediately following intubation. Using tools to rapidly and reliably determine the predicted body weight (PBW), as well as the use of automated modes of ventilation are some of the potential solutions to facilitate the practice of protective ventilation and to finally ventilate our patients' lungs in a more gentle fashion to help prevent ARDS.

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Evaluation Of A New Tool To Measure Patient's Height During Mechanical Ventilation: Impact On Protective Ventilation Implementation

Cited by 3 publications

References 0 publications

Comparison of Usual and Alternative Methods to Measure Height in Mechanically Ventilated Patients: Potential Impact on Protective Ventilation

Comparison of Usual and Alternative Methods to Measure Height in Mechanically Ventilated Patients: Potential Impact on Protective Ventilation

Low Tidal Volume Ventilation in Patients without Acute Respiratory Distress Syndrome: A Paradigm Shift in Mechanical Ventilation

Prophylactic protective ventilation: lower tidal volumes for all critically ill patients?

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