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

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

Research output: Contribution to journalArticle

12 Citations (Scopus)

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 (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)

Original languageEnglish (US)
Pages (from-to)578-588
Number of pages11
JournalRespiratory Care
Volume58
Issue number4
DOIs
StatePublished - Apr 1 2013

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Acute Lung Injury
Mechanical Ventilators
Intubation
Body Weight
Tidal Volume

Keywords

  • Acute lung injury
  • ARDS
  • Mechanical ventilation
  • Mortality
  • Tidal volume

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Chang, S. Y., Dabbagh, O., Gajic, O., Patrawalla, A., Elie, M. C., Talmor, D. S., ... Gong, M. N. (2013). Contemporary ventilator management in patients with and at risk of ALI/ARDS. Respiratory Care, 58(4), 578-588. https://doi.org/10.4187/respcare.01755

Contemporary ventilator management in patients with and at risk of ALI/ARDS. / Chang, Steven Y.; Dabbagh, Ousama; Gajic, Ognen; Patrawalla, Amee; Elie, Marie Carmelle; Talmor, Daniel S.; Malhotra, Atul; Adesanya, Adebola; Anderson, Harry L.; Blum, James M.; Park, Pauline K.; Gong, Michelle Ng.

In: Respiratory Care, Vol. 58, No. 4, 01.04.2013, p. 578-588.

Research output: Contribution to journalArticle

Chang, SY, Dabbagh, O, Gajic, O, Patrawalla, A, Elie, MC, Talmor, DS, Malhotra, A, Adesanya, A, Anderson, HL, Blum, JM, Park, PK & Gong, MN 2013, 'Contemporary ventilator management in patients with and at risk of ALI/ARDS', Respiratory Care, vol. 58, no. 4, pp. 578-588. https://doi.org/10.4187/respcare.01755
Chang SY, Dabbagh O, Gajic O, Patrawalla A, Elie MC, Talmor DS et al. Contemporary ventilator management in patients with and at risk of ALI/ARDS. Respiratory Care. 2013 Apr 1;58(4):578-588. https://doi.org/10.4187/respcare.01755
Chang, Steven Y. ; Dabbagh, Ousama ; Gajic, Ognen ; Patrawalla, Amee ; Elie, Marie Carmelle ; Talmor, Daniel S. ; Malhotra, Atul ; Adesanya, Adebola ; Anderson, Harry L. ; Blum, James M. ; Park, Pauline K. ; Gong, Michelle Ng. / Contemporary ventilator management in patients with and at risk of ALI/ARDS. In: Respiratory Care. 2013 ; Vol. 58, No. 4. pp. 578-588.
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AU - Chang, Steven Y.

AU - Dabbagh, Ousama

AU - Gajic, Ognen

AU - Patrawalla, Amee

AU - Elie, Marie Carmelle

AU - Talmor, Daniel S.

AU - Malhotra, Atul

AU - Adesanya, Adebola

AU - Anderson, Harry L.

AU - Blum, James M.

AU - Park, Pauline K.

AU - Gong, Michelle Ng

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N2 - 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)

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KW - Acute lung injury

KW - ARDS

KW - Mechanical ventilation

KW - Mortality

KW - Tidal volume

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