What Tidal Volumes Should Be Used in Patients without Acute Lung Injury?

Schultz, Marcus J.; Haitsma, Jack J.; Slutsky, Arthur S.; Gajic, Ognjen

doi:10.1097/01.anes.0000267607.25011.e8

Cited by 246 publications

(158 citation statements)

References 43 publications

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“…The findings of this study raise concerns about this relevant issue, given that higher than physiological tidal volumes have been associated with the development of ARDS in patients on mechanical ventilation for causes other than ARDS [20].…”

mentioning

confidence: 85%

The FINNALI study on acute respiratory failure: not the final cut

Bakker

2009

Intensive Care Med

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mentioning

confidence: 85%

The FINNALI study on acute respiratory failure: not the final cut

Bakker

2009

Intensive Care Med

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“…Visual estimation of height should definitively be avoided, as well as the use of actual body weight to determine V T . 10 The optimum V T to prevent 5,42 or treat 4 ARDS in mechanically ventilated patients is still not clearly defined. It is well accepted, however, that high V T increases mortality in ARDS patients 1,4 and is associated with poor outcome in patients without ARDS.…”

Section: Clinical Relevancementioning

confidence: 99%

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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“…However, there is no consensus on the optimal initial V T in patients without ALI. 8 At our tertiary care center, pilot data showed that a large proportion of our patients were receiving an initial V T of Ͼ 10 mL/kg ideal body weight (IBW). Poor compliance with ventilation strategy guidelines/expert opinions can be seen throughout the literature.…”

Section: Introductionmentioning

confidence: 93%

Better Ventilator Settings Using a Computerized Clinical Tool

et al. 2013

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BACKGROUND: The Acute Respiratory Distress Syndome (ARDS) Network low tidal volume (V T )trial paved the ground for mechanically ventilating ARDS patients with a V T of 6 mL/kg ideal body weight (IBW). Although there is no consensus that a low V T is advantageous in non-ARDS patients, it is accepted that high V T should be avoided. Because compliance rates with ventilator recommendations are 30%, there is a need for process improvement. We postulated that a computerized screen prompt that recommended V T based on height would improve compliance with low V T . During ventilator order entry, the computerized decision tool prompts the clinician and encourages ventilation of patients at 8 mL/kg IBW, and 6 mL/kg IBW for patients with ARDS. METHODS: A retrospective review was performed on patients who required volume controlled mechanical ventilation over a 3-y period. Subjects were chosen randomly from the respiratory records of 6 different ICUs at a single tertiary care academic center. Half of the charts selected were before intervention of on-screen prompt, and the other half were after implementation of the computerized decision tool. RESULTS: The initial set V T ranged from 6.26 to 13.45 mL/kg IBW, with a mean of 8.92 mL/kg. After implementation of the on-screen prompt, mean V T decreased by 0.84 mL/kg to 8.07 mL/kg (P ‫؍‬ .001) with a lower range of 4.73-11.56 mL/kg IBW. We also noted a significant decrease in the number of subjects placed on an initial V T > 10 mL/kg IBW from 20% to 4% (P ‫؍‬ .003). CONCLUSIONS: A computerized clinical decision tool with the preferred initial V T settings based on the patients' sex and height is a safe and reliable way to increase low V T strategy compliance across multiple ICUs. Its limitations are similar to those shared by other computergenerated prompts.

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What Tidal Volumes Should Be Used in Patients without Acute Lung Injury?

Cited by 246 publications

References 43 publications

The FINNALI study on acute respiratory failure: not the final cut

The FINNALI study on acute respiratory failure: not the final cut

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

Better Ventilator Settings Using a Computerized Clinical Tool

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