The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts

TIDAL VOLUME IS INDEPENDENTLY ASSOCIATED WITH OUTCOME IN CRITICALLY ILL PATIENTS RECEIVING MECHANICAL VENTILATION.

Rory A. Mullin, Vince Roberts, Martha Lemin, Edward Hoisington, Madhu Sasidhar; Respiratory Institute, Cleveland Clinic, Cleveland, OH

BACKGROUND: High tidal volume has been associated with poor outcome in patients with acute lung injury [ALI] or Adult Respiratory Distress Syndrome [ARDS]. Use of high tidal volumes has been associated with elevation in biomarkers of lung injury, prolongation of duration of mechanical ventilation as well as increased mortality. There are few studies that document the effect of high tidal volumes in patients who are not admitted with a diagnosis of ALS/ARDS. METHODS: Retrospective review of tidal volumes during mechanical ventilation, patient ideal body weight and APACHE IV outcome data was performed on patients admitted to our medical intensive care unit. RESULTS: Tidal Volume (TV) of 8mL/kg predicted body weight (PBW) was used to divide the patients in two groups. Of 677 ICU admissions, 572 received TV of more than 8mL/kg at some point during their ICU stay as opposed to 105 patients whose TV remained less than 8 mL/kg PBW. Patients who received TV of more than 8mL/kg had significantly higher ICU mortality compared to those with lower tidal volumes (26.8% versus 17.6%; p-value = 0.05). Patients in higher TV group also had significantly longer ICU stays. Hospital length of stay, or functional status at the time of discharge did not show a statistically significant correlation with the tidal volume. CONCLUSION: Based on our retrospective analysis, we recommend careful monitoring to maintain low tidal volumes in mechanically ventilated patients including those with non-respiratory critical illness.
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