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Title: Ventilation management in Victorian intensive care unit patients without acute respiratory distress syndrome.
Authors: Eyeington, Christopher T;Glassford, Neil J;Darvall, Jai;Casamento, Andrew;Haydon, Tim;Taori, Gopal;Knott, Cameron;McGain, Forbes;Vetro, Joseph;Simpson, Nick;Sarode, Vineet;Richardson, Angus;Dunnachie, Charles;Crisman, Marco;Musci, Jason;Woinarski, Nicholas C Z;Lynham, Rohan;Eastwood, Glenn M;Bellomo, Rinaldo;Karalapillai, Dharshi
Affiliation: Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
The Royal Melbourne Hospital, Melbourne, Vic, Australia
St Vincent's Hospital, Melbourne, Vic, Australia
Monash Medical Centre, Melbourne, Vic, Australia
Footscray Hospital, Melbourne, Vic, Australia
Box Hill Hospital, Melbourne, Vic, Australia
University Hospital Geelong, Geelong, Vic, Australia
Maroondah Hospital, Maroondah, Vic, Australia
Ballarat Base Hospital, Ballarat, Vic, Australia
Issue Date: Jun-2018
Citation: Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine 2018; 20(2): 101-108
Abstract: The setting of tidal volume (VT) during controlled mechanical ventilation (CMV) in critically ill patients without acute respiratory distress syndrome (ARDS) is likely important but currently unknown. We aimed to describe current CMV settings in intensive care units (ICUs) across Victoria. We performed a multicentre, prospective, observational study. We collected clinical, ventilatory and arterial blood gas data twice daily for 7 days. We performed subgroup analysis by sex and assessment of arterial partial pressure of carbon dioxide (PaCO2) management where hypercapnia was potentially physiologically contraindicated. We recorded 453 observational sets in 123 patients across seven ICUs. The most commonly selected initial VT was 500 mL (33%), and this proportion did not differ according to sex (32% male, 34% female). Moreover, 38% of patients were exposed to initial VT per predicted body weight (VT-PBW) > 8.0 mL/kg. VT-PBW in this range were more likely to occur in females, those with a lower height, lower ideal body weight or in those for whom hypercapnia was potentially physiologically contraindicated. As a consequence, females were more frequently exposed to a lower PaCO2 and higher pH. In adults without ARDS undergoing CMV in Australian ICUs, the initial VT was a stereotypical 500 mL in one-third of participants, irrespective of sex. Moreover, around 40% of patients were exposed to an initial VT-PBW > 8.0 mL/kg. Finally, women were more likely to be exposed to a high VT and hyperventilation.
PubMed URL: 29852848
ISSN: 1441-2772
Type: Journal Article
Appears in Collections:Journal articles

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