Ventilation of patients with acute lung injury and acute respiratory distress syndrome: has new evidence changed clinical practice?
Crit Care Med
; 32(6): 1260-5, 2004 Jun.
Article
em En
| MEDLINE
| ID: mdl-15187503
ABSTRACT
OBJECTIVES:
A recent randomized trial of mechanical ventilation in acute lung injury (ALI)/adult respiratory distress syndrome (ARDS) demonstrated a 22% relative reduction in mortality rate using 6 mL/kg predicted body weight tidal volume vs. 12 mL/kg predicted body weight tidal volume. We determined whether publication of these findings changed clinical practice.DESIGN:
Retrospective cohort, 12 months before (Pre) and 12 months after publication (Post) of a randomized trial supporting the use of a 6 mL/kg predicted body weight tidal volume strategy.SETTING:
Three tertiary care hospitals in northern New England. PATIENTS From a sample of 943 patients receiving prolonged mechanical ventilation between 1998 and 1999 (Pre) and between 2000 and 2001 (Post), 300 patients meeting the American-European Consensus Conference definition of ALI or ARDS were selected for analysis.INTERVENTIONS:
The tidal volume, tidal volume/kg predicted body weight, and proportion receiving tidal volume/kg > or =6 mL/kg and < or =12 mL/kg predicted body weight were recorded at noon the first day after the diagnosis of ALI or ARDS was established. MEASUREMENTS AND MAINRESULTS:
Pre and Post mean tidal volume (+/- sd) size and tidal volume size/kg predicted body weight were 759 +/- 158 mL (median 750 mL) vs. 639 +/- 138 mL (median 600 mL, p <.001) and 12.3 +/- 2.7 mL/kg (median 11.7 mL/kg) vs. 10.6 +/- 2.4 mL/kg (median 10.7 mL/kg, p <.001) respectively. Pre and Post plateau pressures and peak airway pressures were similar.CONCLUSION:
Publication of a trial demonstrating large mortality reductions using small tidal volume was associated with significant reductions in tidal volume delivered to patients with ALI/ARDS. However, wide variation in practice persists, and the proportion of patients receiving tidal volumes within recommended limits (< or =8 mL/kg) remains modest.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Respiração Artificial
/
Síndrome do Desconforto Respiratório
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Crit Care Med
Ano de publicação:
2004
Tipo de documento:
Article
País de afiliação:
Estados Unidos