Curtis H Weiss1, David W Baker, Shayna Weiner, Meagan Bechel, Margaret Ragland, Alfred Rademaker, Bing Bing Weitner, Abha Agrawal, Richard G Wunderink, Stephen D Persell. 1. 1Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. 2Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL. 3The Joint Commission, Oakbrook Terrace, IL. 4University of Michigan School of Medicine, Ann Arbor, MI. 5Northwestern University Feinberg School of Medicine, Chicago, IL. 6Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. 7Department of Preventive Medicine-Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL. 8Norwegian American Hospital, Chicago, IL.
Abstract
OBJECTIVE: Low tidal volume ventilation lowers mortality in the acute respiratory distress syndrome. Previous studies reported poor low tidal volume ventilation implementation. We sought to determine the rate, quality, and predictors of low tidal volume ventilation use. DESIGN: Retrospective cross-sectional study. SETTING: One academic and three community hospitals in the Chicago region. PATIENTS: A total of 362 adults meeting the Berlin Definition of acute respiratory distress syndrome consecutively admitted between June and December 2013. MEASUREMENTS AND MAIN RESULTS: Seventy patients (19.3%) were treated with low tidal volume ventilation (tidal volume < 6.5 mL/kg predicted body weight) at some time during mechanical ventilation. In total, 22.2% of patients requiring an FIO2 greater than 40% and 37.3% of patients with FIO2 greater than 40% and plateau pressure greater than 30 cm H2O received low tidal volume ventilation. The entire cohort received low tidal volume ventilation 11.4% of the time patients had acute respiratory distress syndrome. Among patients who received low tidal volume ventilation, the mean (SD) percentage of acute respiratory distress syndrome time it was used was 59.1% (38.2%), and 34% waited more than 72 hours prior to low tidal volume ventilation initiation. Women were less likely to receive low tidal volume ventilation, whereas sepsis and FIO2 greater than 40% were associated with increased odds of low tidal volume ventilation use. Four attending physicians (6.2%) initiated low tidal volume ventilation within 1 day of acute respiratory distress syndrome onset for greater than or equal to 50% of their patients, whereas 34 physicians (52.3%) never initiated low tidal volume ventilation within 1 day of acute respiratory distress syndrome onset. In total, 54.4% of patients received a tidal volume less than 8 mL/kg predicted body weight, and the mean tidal volume during the first 72 hours after acute respiratory distress syndrome onset was never less than 8 mL/kg predicted body weight. CONCLUSIONS: More than 12 years after publication of the landmark low tidal volume ventilation study, use remains poor. Interventions that improve adoption of low tidal volume ventilation are needed.
OBJECTIVE: Low tidal volume ventilation lowers mortality in the acute respiratory distress syndrome. Previous studies reported poor low tidal volume ventilation implementation. We sought to determine the rate, quality, and predictors of low tidal volume ventilation use. DESIGN: Retrospective cross-sectional study. SETTING: One academic and three community hospitals in the Chicago region. PATIENTS: A total of 362 adults meeting the Berlin Definition of acute respiratory distress syndrome consecutively admitted between June and December 2013. MEASUREMENTS AND MAIN RESULTS: Seventy patients (19.3%) were treated with low tidal volume ventilation (tidal volume < 6.5 mL/kg predicted body weight) at some time during mechanical ventilation. In total, 22.2% of patients requiring an FIO2 greater than 40% and 37.3% of patients with FIO2 greater than 40% and plateau pressure greater than 30 cm H2O received low tidal volume ventilation. The entire cohort received low tidal volume ventilation 11.4% of the time patients had acute respiratory distress syndrome. Among patients who received low tidal volume ventilation, the mean (SD) percentage of acute respiratory distress syndrome time it was used was 59.1% (38.2%), and 34% waited more than 72 hours prior to low tidal volume ventilation initiation. Women were less likely to receive low tidal volume ventilation, whereas sepsis and FIO2 greater than 40% were associated with increased odds of low tidal volume ventilation use. Four attending physicians (6.2%) initiated low tidal volume ventilation within 1 day of acute respiratory distress syndrome onset for greater than or equal to 50% of their patients, whereas 34 physicians (52.3%) never initiated low tidal volume ventilation within 1 day of acute respiratory distress syndrome onset. In total, 54.4% of patients received a tidal volume less than 8 mL/kg predicted body weight, and the mean tidal volume during the first 72 hours after acute respiratory distress syndrome onset was never less than 8 mL/kg predicted body weight. CONCLUSIONS: More than 12 years after publication of the landmark low tidal volume ventilation study, use remains poor. Interventions that improve adoption of low tidal volume ventilation are needed.
Authors: G R Bernard; A Artigas; K L Brigham; J Carlet; K Falke; L Hudson; M Lamy; J R Legall; A Morris; R Spragg Journal: Am J Respir Crit Care Med Date: 1994-03 Impact factor: 21.405
Authors: Guangxi Li; Michael Malinchoc; Rodrigo Cartin-Ceba; Chakradhar V Venkata; Daryl J Kor; Steve G Peters; Rolf D Hubmayr; Ognjen Gajic Journal: Am J Respir Crit Care Med Date: 2010-08-06 Impact factor: 21.405
Authors: Gordon D Rubenfeld; Ellen Caldwell; Eve Peabody; Jim Weaver; Diane P Martin; Margaret Neff; Eric J Stern; Leonard D Hudson Journal: N Engl J Med Date: 2005-10-20 Impact factor: 91.245
Authors: Christian Putensen; Nils Theuerkauf; Jörg Zinserling; Hermann Wrigge; Paolo Pelosi Journal: Ann Intern Med Date: 2009-10-20 Impact factor: 25.391
Authors: V Marco Ranieri; Gordon D Rubenfeld; B Taylor Thompson; Niall D Ferguson; Ellen Caldwell; Eddy Fan; Luigi Camporota; Arthur S Slutsky Journal: JAMA Date: 2012-06-20 Impact factor: 56.272
Authors: Brian M Fuller; Ian T Ferguson; Nicholas M Mohr; Anne M Drewry; Christopher Palmer; Brian T Wessman; Enyo Ablordeppey; Jacob Keeperman; Robert J Stephens; Cristopher C Briscoe; Angelina A Kolomiets; Richard S Hotchkiss; Marin H Kollef Journal: Crit Care Med Date: 2017-04 Impact factor: 7.598
Authors: Hallie C Prescott; Tara M Cope; Foster C Gesten; Tatiana A Ledneva; Marcus E Friedrich; Theodore J Iwashyna; Tiffany M Osborn; Christopher W Seymour; Mitchell M Levy Journal: Crit Care Med Date: 2018-05 Impact factor: 7.598
Authors: Curtis H Weiss; David W Baker; Katrina Tulas; Shayna Weiner; Meagan Bechel; Alfred Rademaker; Angela Fought; Richard G Wunderink; Stephen D Persell Journal: Ann Am Thorac Soc Date: 2017-11
Authors: Curtis H Weiss; Jakob I McSparron; Rohini S Chatterjee; Derrick Herman; Eddy Fan; Kevin C Wilson; Carey C Thomson Journal: Ann Am Thorac Soc Date: 2017-08
Authors: Gail G Weinmann; Thomas L Croxton; Neil R Aggarwal; Michael J Twery; James P Kiley Journal: Am J Respir Crit Care Med Date: 2019-12-15 Impact factor: 21.405
Authors: Meeta Prasad Kerlin; Andrew Epstein; Jeremy M Kahn; Theodore J Iwashyna; David A Asch; Michael O Harhay; Sarah J Ratcliffe; Scott D Halpern Journal: Ann Am Thorac Soc Date: 2018-03
Authors: Matthew Schwede; Robert Y Lee; Hanjing Zhuo; Kirsten N Kangelaris; Alejandra Jauregui; Kathryn Vessel; Annika Belzer; Thomas Deiss; Michael A Matthay; Kathleen D Liu; Carolyn S Calfee Journal: Crit Care Med Date: 2020-06 Impact factor: 7.598