1/26/2024 0 Comments Ards tidal volume![]() ![]() We conducted this study to analyze the current rate of LTVV use for ARDS in several non-ARDSNet academic and community medical centers using the Berlin Definition of ARDS, continuous ventilator data, and an expanded list of LTVV predictors.( 1) We hypothesized that implementation of LTVV would be low despite conducting this study more than one dozen years after the publication of the landmark ARDSNet study.( 4) ![]() Either they were conducted more than eight years ago, used an outdated definition of ARDS, evaluated LTVV utilization only once or twice daily, or did not thoroughly examine predictors of LTVV use. In addition, prior studies have important limitations. 54.4% of patients received a tidal volume <8ml/kg PBW, and the mean tidal volume during the first 72 hours after ARDS onset was never less than 8mL/kg PBW.Īcute respiratory distress syndrome (ARDS), including the commonly used term acute lung injury, is a clinical syndrome of acute severe hypoxemia due to bilateral non-cardiogenic pulmonary edema.( 1) ARDS is commonly diagnosed in critically ill patients and is associated with high mortality and morbidity.( 1– 3) Low tidal volume ventilation (LTVV) is the most extensively investigated ARDS therapy that improves mortality in patients with ARDS.( 4– 8) The target of LTVV is a tidal volume of 6 mL/kg predicted body weight (PBW) (some definitions include a target pressure during an end-inspiratory hold maneuver, or plateau pressure, less than or equal to 30 cm H 2O).( 4, 9)ĭespite strong clinical trial evidence of its effectiveness( 4– 6, 10) and its inclusion in at least one major clinical practice guideline,( 11) LTVV remains under-used.( 5, 6, 12– 18) Many studies reporting low LTVV use come from the same ARDS Network (ARDSNet) institutions that first studied the LTVV intervention ( 5, 6, 13, 14) less is known about LTVV adoption in other hospitals. Four attending physicians (6.2%) initiated LTVV within one day of ARDS onset for ≥50% of their patients, whereas 34 physicians (52.3%) never initiated LTVV within one day of ARDS onset. Women were less likely to receive LTVV, whereas sepsis and F IO 2>40% were associated with increased odds of LTVV use. Among patients who received LTVV, the mean (SD) percentage of ARDS time it was used was 59.1% (38.2%), and 34% waited more than 72 hours prior to LTVV initiation. ![]() The entire cohort received LTVV 11.4% of the time patients had ARDS. Seventy patients (19.3%) were treated with LTVV (tidal volume 40% and 37.3% of patients with F IO 2>40% and plateau pressure >30cm H 2O received LTVV. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |