HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (7) Citing Articles via Google Scholar Google Scholar Articles by Wongsurakiat, P. Articles by Rubenfeld, G. D. Search for Related Content PubMed PubMed Citation Articles by Wongsurakiat, P. Articles by Rubenfeld, G. D.

Changing Pattern of Ventilator Settings in Patients Without Acute Lung Injury

Changes Over 11 Years in a Single Institution*

Correspondence to: Phunsup Wongsurakiat, MD, FCCP, Division of Respiratory Disease and Tuberculosis, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; e-mail: sipwo{at}mahidol.ac.th

Study objectives: To determine whether the widely accepted concept of using lower tidal volume (VT) values in patients with ARDS or obstructive lung disease has affected the pattern of ventilator settings in mechanically ventilated patients who do not have one of these conditions.

Design and patients: We performed a retrospective chart review of all patients who had experienced out-of-hospital cardiac arrest and had received ventilatory support for 1 day at a university-affiliated county hospital during the years 1990, 1991, 1992, 1995, 1998, 1999, and 2000.

Results: In 139 such patients, the mean final VT values used on the first day of mechanical ventilation were 11.7, 12.4, 11.3, 9.6, 9.7, 9.2, and 9.8 mL/kg in those years, respectively. Multivariate analysis revealed that increasing year (ß-coefficient = –0.24; p = 0.001) and the presence of pulmonary edema (ß-coefficient = –1.2; p = 0.001) were independent predictors of the use of lower VT values. Patients managed with a low VT (ie, < 10 mL/kg; mean [± SD] VT, 8.4 ± 1.3 mL/kg) had a significantly higher incidence of atelectasis than the patients who were managed with traditional, larger VT values (ie, 10 mL/kg; mean VT, 11.8 ± 1.5 mL/kg) [61.1% vs 36.7%, respectively; p = 0.02]. Multivariate analysis revealed that the mean VT used on days 1, 2, and 3 (<10 mL/kg or 10 mL/kg) was the only predictor of the development of atelectasis during the first 3 days of mechanical ventilation (odds ratio, 0.33; p = 0.015). There was no difference in the incidence of pneumonia, the number of days spent receiving mechanical ventilation, PaO₂/fraction of inspired oxygen ratio, or respiratory system compliance between the low VT group and the traditional VT group.

Conclusion: Currently, physicians at our hospital use lower VT values than they have in the past. This is associated with the increase in the incidence of atelectasis in the patients who received ventilation using low VT values.

Key Words: atelectasis • cardiac arrest • oxygenation • respiratory system compliance • tidal volume

This article has been cited by other articles:

				T. J. Gal Con: low tidal volumes are indicated during one-lung ventilation. Anesth. Analg., August 1, 2006; 103(2): 271 - 273. [Full Text] [PDF]