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

doi:10.4187/respcare.01755

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

Medicine

Research output: Contribution to journal › Article › peer-review

18 Scopus citations

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 (V_T), and whether V_T < 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 V_T < 8 mL/kg PBW and the relationship of V_T 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 V_T 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). V_T 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, V_T ≥ 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 V_T ≥ 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 V_T. Initial V_T, however, was not associated with the development of post-intubation ALI/ARDS or other outcomes. (ClinicalTrials.gov registration NCT00889772)

Original language	English (US)
Pages (from-to)	578-588
Number of pages	11
Journal	Respiratory care
Volume	58
Issue number	4
DOIs	https://doi.org/10.4187/respcare.01755
State	Published - Apr 1 2013

Keywords

ARDS
Acute lung injury
Mechanical ventilation
Mortality
Tidal volume

ASJC Scopus subject areas

Pulmonary and Respiratory Medicine
Critical Care and Intensive Care Medicine

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10.4187/respcare.01755

Cite this

@article{e9ae7e403f1542d98e4c0044b89af8c6,

title = "Contemporary ventilator management in patients with and at risk of ALI/ARDS",

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)",

keywords = "ARDS, Acute lung injury, Mechanical ventilation, Mortality, Tidal volume",

author = "Chang, {Steven Y.} and Ousama Dabbagh and Ognen Gajic and Amee Patrawalla and Elie, {Marie Carmelle} and Talmor, {Daniel S.} and Atul Malhotra and Adebola Adesanya and Anderson, {Harry L.} and Blum, {James M.} and Park, {Pauline K.} and Gong, {Michelle Ng}",

year = "2013",

month = apr,

day = "1",

doi = "10.4187/respcare.01755",

language = "English (US)",

volume = "58",

pages = "578--588",

journal = "Respiratory care",

issn = "0020-1324",

publisher = "Daedalus Enterprises Inc.",

number = "4",

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TY - JOUR

T1 - Contemporary ventilator management in patients with and at risk of ALI/ARDS

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

PY - 2013/4/1

Y1 - 2013/4/1

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)

AB - 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)

KW - ARDS

KW - Acute lung injury

KW - Mechanical ventilation

KW - Mortality

KW - Tidal volume

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U2 - 10.4187/respcare.01755

DO - 10.4187/respcare.01755

M3 - Article

C2 - 22906363

AN - SCOPUS:84876179246

SN - 0020-1324

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SP - 578

EP - 588

JO - Respiratory care

JF - Respiratory care

IS - 4

ER -

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

Abstract

Keywords

ASJC Scopus subject areas

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