Advertisement

Universal Low Tidal Volume: Early Initiation of Low Tidal Volume Ventilation in Patients with and without ARDS

  • J.-T. Chen
  • M. N. GongEmail author
Chapter
Part of the Annual Update in Intensive Care and Emergency Medicine book series (AUICEM)

Abstract

Lung protective ventilation using 6 mL/kg of ideal body weight is the standard of practice in patients with acute respiratory distress syndrome (ARDS). The use of low tidal volume ventilation was associated with decreased morbidity and mortality in the ARMA trial [1]. The use of low tidal volume of 6 mL/kg of predicted body weight (PBW) conferred a mortality reduction of 22% [1]. A recent large epidemiologic study, LUNG SAFE, demonstrated that not only is ARDS underdiagnosed, there is also a significant delay in recognition [2]. There is growing evidence in support of the use of low tidal volume ventilation as early as possible in patients with acute respiratory failure, both with and without ARDS [3, 4]. Given that as many as half of the patients admitted to the intensive care unit (ICU) come directly from the emergency department (ED) [5], and many others come to the ICU after major surgery, it is important to understand ventilator practices for patients in the ED and operating rooms and how these practices in the early part of mechanical ventilation may be important to the later outcomes of patients.

References

  1. 1.
    Bower RG, Matthay MA, Morris A, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000;342:1301–8.CrossRefGoogle Scholar
  2. 2.
    Bellani G, Laffey JG, Pham T, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016;315:788–800.CrossRefGoogle Scholar
  3. 3.
    Fuller BM, Mohr NM, Drewry AM, et al. Lower tidal volume at initiation of mechanical ventilation may reduce progression to acute respiratory distress syndrome: a systematic review. Crit Care. 2013;17:R11.CrossRefGoogle Scholar
  4. 4.
    Serpa Neto A, Cardoso SO, Manetta JA, et al. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA. 2012;308:1651–9.CrossRefGoogle Scholar
  5. 5.
    Lilly CM, Zuckerman IH, Badawi O, et al. Benchmark data from more than 240,000 adults that reflect the current practice of critical care in the United States. Chest. 2011;140:1232–42.CrossRefGoogle Scholar
  6. 6.
    Sutherasan Y, Vargas M, Pelosi P. Protective mechanical ventilation in the non-injured lung: review and meta-analysis. Crit Care. 2014;18:211.CrossRefGoogle Scholar
  7. 7.
    Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med. 2013;369:2126–36.CrossRefGoogle Scholar
  8. 8.
    Fan E, Del Sorbo L, Goligher EC, et al. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: mechanical ventilation in adult patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2017;195:1253–63.CrossRefGoogle Scholar
  9. 9.
    Needham DM, Yang T, Dinglas VD, et al. Timing of low tidal volume ventilation and intensive care unit mortality in acute respiratory distress syndrome. A prospective cohort study. Am J Respir Crit Care Med. 2015;191:177–85.CrossRefGoogle Scholar
  10. 10.
    Checkley W, Brower R, Korpak A, et al. Effects of a clinical trial on mechanical ventilation practices in patients with acute lung injury. Am J Respir Crit Care Med. 2008;177:1215–22.CrossRefGoogle Scholar
  11. 11.
    Cornish S, Wynne R, Klim S, Kelly AM. Protective lung strategies: a cross sectional survey of nurses knowledge and use in the emergency department. Australas Emerg Nurs J. 2017;20:87–91.CrossRefGoogle Scholar
  12. 12.
    Fuller BM, Mohr NM, Dettmer M, et al. Mechanical ventilation and acute lung injury in emergency department patients with severe sepsis and septic shock: an observational study. Acad Emerg Med. 2013;20:659–69.CrossRefGoogle Scholar
  13. 13.
    Fuller BM, Mohr NM, Miller CN, et al. Mechanical ventilation and ARDS in the ED: a multicenter, observational, prospective, cross-sectional study. Chest. 2015;148:365–74.CrossRefGoogle Scholar
  14. 14.
    Futier E, Constantin JM, Paugam-Burtz C, et al. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med. 2013;369:428–37.CrossRefGoogle Scholar
  15. 15.
    Fuller BM, Ferguson IT, Mohr NM, et al. Lung-protective ventilation initiated in the emergency department (LOV-ED): a quasi-experimental, before-after trial. Ann Emerg Med. 2017;70:406–18. e404CrossRefGoogle Scholar
  16. 16.
    Determann RM, Royakkers A, Wolthuis EK, et al. Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial. Crit Care. 2010;14:R1.CrossRefGoogle Scholar
  17. 17.
    Allison MG, Scott MC, Hu KM, et al. High initial tidal volumes in emergency department patients at risk for acute respiratory distress syndrome. J Crit Care. 2015;30:341–3.CrossRefGoogle Scholar
  18. 18.
    Gajic O, Frutos-Vivar F, Esteban A, et al. Ventilator settings as a risk factor for acute respiratory distress syndrome in mechanically ventilated patients. Intensive Care Med. 2005;31:922–6.CrossRefGoogle Scholar
  19. 19.
    Neto AS, Simonis FD, Barbas CS, et al. Lung-protective ventilation with low tidal volumes and the occurrence of pulmonary complications in patients without acute respiratory distress syndrome: a systematic review and individual patient data analysis. Crit Care Med. 2015;43:2155–63.CrossRefGoogle Scholar
  20. 20.
    Sjoding MW, Gong MN, Hass MLS, Iwashyna TJ. Evaluating delivery of low tidal volume ventilation in six ICUs using electronic health record data. Crit Care Med. 2019;47:56–61.Google Scholar
  21. 21.
    Simonis FD, Binnekade JM, Braber A, et al. PReVENT—protective ventilation in patients without ARDS at start of ventilation: study protocol for a randomized controlled trial. Trials. 2015;16:226.Google Scholar
  22. 22.
    Anonymous. PRotective VENTilation in Patients Without ARDS (PReVENT-NL) NCT02153294. 2014. https://clinicaltrialsgov/ct2/show/study/NCT02153294. Accessed 8 Oct 2018.
  23. 23.
    Wanderer JP, Blum JM, Ehrenfeld JM. Intraoperative low-tidal-volume ventilation. N Engl J Med. 2013;369:1861.CrossRefGoogle Scholar
  24. 24.
    PROVHILO Investigators. High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial. Lancet. 2014;384:495–503.CrossRefGoogle Scholar
  25. 25.
    Gu WJ, Wang F, Liu JC. Effect of lung-protective ventilation with lower tidal volumes on clinical outcomes among patients undergoing surgery: a meta-analysis of randomized controlled trials. CMAJ. 2015;187:E101–9.CrossRefGoogle Scholar
  26. 26.
    Kroell W, Metzler H, Struber G, et al. Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS—an observational study in 29 countries. Eur J Anaesthesiol. 2017;34:492–507.Google Scholar
  27. 27.
    Fryar CD, Gu Q, Ogden CL, Flegal KM. Anthropometric reference data for children and adults: United States, 2011–2014. Vital Health Stat. 2016;2016:1–46.Google Scholar
  28. 28.
    Sasko B, Thiem U, Christ M, et al. Size matters: an observational study investigating estimated height as a reference size for calculating tidal volumes if low tidal volume ventilation is required. PLoS One. 2018;13:e0199917.CrossRefGoogle Scholar
  29. 29.
    Han S, Martin GS, Maloney JP, et al. Short women with severe sepsis-related acute lung injury receive lung protective ventilation less frequently: an observational cohort study. Crit Care. 2011;15:R262.CrossRefGoogle Scholar
  30. 30.
    Bhat R, Goyal M, Graf S, et al. Impact of post-intubation interventions on mortality in patients boarding in the emergency department. West J Emerg Med. 2014;15:708–11.CrossRefGoogle Scholar
  31. 31.
    Goyal M, Houseman D, Johnson NJ, et al. Prevalence of acute lung injury among medical patients in the emergency department. Acad Emerg Med. 2012;19:E1011–8.CrossRefGoogle Scholar
  32. 32.
    Kor DJ, Talmor DS, Banner-Goodspeed VM, et al. Lung Injury Prevention with Aspirin (LIPS-A): a protocol for a multicentre randomised clinical trial in medical patients at high risk of acute lung injury. BMJ Open. 2012;2:e001606.CrossRefGoogle Scholar
  33. 33.
    Wilcox SR, Richards JB, Fisher DF, et al. Initial mechanical ventilator settings and lung protective ventilation in the ED. Am J Emerg Med. 2016;34:1446–51.CrossRefGoogle Scholar
  34. 34.
    Stoltze AJ, Wong TS, Harland KK, et al. Prehospital tidal volume influences hospital tidal volume: a cohort study. J Crit Care. 2015;30:495–501.CrossRefGoogle Scholar
  35. 35.
    Perbet S, Mongardon N, Dumas F, et al. Early-onset pneumonia after cardiac arrest: characteristics, risk factors and influence on prognosis. Am J Respir Crit Care Med. 2011;184:1048–54.CrossRefGoogle Scholar
  36. 36.
    Sutherasan Y, Penuelas O, Muriel A, et al. Management and outcome of mechanically ventilated patients after cardiac arrest. Crit Care. 2015;19:215.CrossRefGoogle Scholar
  37. 37.
    Harmon MBA, van Meenen DMP, van der Veen A, et al. Practice of mechanical ventilation in cardiac arrest patients and effects of targeted temperature management: a substudy of the targeted temperature management trial. Resuscitation. 2018;129:29–36.CrossRefGoogle Scholar
  38. 38.
    Johnson NJ, Carlbom DJ, Gaieski DF. Ventilator management and respiratory care after cardiac arrest: oxygenation, ventilation, infection, and injury. Chest. 2018;153:1466–77.CrossRefGoogle Scholar
  39. 39.
    Beitler JR, Ghafouri TB, Jinadasa SP, et al. Favorable neurocognitive outcome with low tidal volume ventilation after cardiac arrest. Am J Respir Crit Care Med. 2017;195:1198–206.CrossRefGoogle Scholar
  40. 40.
    Dumont TM, Visioni AJ, Rughani AI, et al. Inappropriate prehospital ventilation in severe traumatic brain injury increases in-hospital mortality. J Neurotrauma. 2010;27:1233–41.CrossRefGoogle Scholar
  41. 41.
    Mascia L, Zavala E, Bosma K, et al. High tidal volume is associated with the development of acute lung injury after severe brain injury: an international observational study. Crit Care Med. 2007;35:1815–20.CrossRefGoogle Scholar
  42. 42.
    Holland MC, Mackersie RC, Morabito D, et al. The development of acute lung injury is associated with worse neurologic outcome in patients with severe traumatic brain injury. J Trauma. 2003;55:106–11.CrossRefGoogle Scholar
  43. 43.
    Nemer SN, Caldeira JB, Santos RG, et al. Effects of positive end-expiratory pressure on brain tissue oxygen pressure of severe traumatic brain injury patients with acute respiratory distress syndrome: a pilot study. J Crit Care. 2015;30:1263–6.CrossRefGoogle Scholar
  44. 44.
    Wright BJ, Slesinger TL. Low tidal volume should not routinely be used for emergency department patients requiring mechanical ventilation. Ann Emerg Med. 2012;60:216–7.CrossRefGoogle Scholar
  45. 45.
    Elmer J, Huang DT. Lung-protective ventilation in the emergency department. Ann Emerg Med. 2017;70:419–20.CrossRefGoogle Scholar
  46. 46.
    Halpern SD. Using default options and other nudges to improve critical care. Crit Care Med. 2018;46:460–4.CrossRefGoogle Scholar
  47. 47.
    Kahn JM, Andersson L, Karir V, et al. Low tidal volume ventilation does not increase sedation use in patients with acute lung injury. Crit Care Med. 2005;33:766–71.CrossRefGoogle Scholar
  48. 48.
    Serpa Neto A, Simonis FD, Barbas CS, et al. Association between tidal volume size, duration of ventilation, and sedation needs in patients without acute respiratory distress syndrome: an individual patient data meta-analysis. Intensive Care Med. 2014;40:950–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Critical CareMontefiore Medical CenterNew YorkUSA

Personalised recommendations