Critical Care Medicine

Adult Critical Care

A Description of Intraoperative Ventilator Management in Patients with Acute Lung Injury and the Use of Lung Protective Ventilation Strategies

Blum JM, Maile M, Park PK, et al (Univ of Michigan Health System, Ann Arbor) Anesthesiology 115:75-82, 2011^§

Abstract

Background

The incidence of acute lung injury (ALI) in hypoxic patients undergoing surgery is currently unknown. Previous studies have identified lung protective ventilation strategies that are beneficial in the treatment of ALI. The authors sought to determine the incidence and examine the use of lung protective ventilation strategies in patients receiving anesthetics with a known history of ALI.

Methods

The ventilation parameters that were used in all patients were reviewed, with an average preoperative Paco₂/Fio₂ ratio of ≤300 between January 1, 2005 and July 1, 2009. This dataset was then merged with a dataset of patients screened for ALI. The median tidal volume, positive end-expiratory pressure, peak inspiratory pressures, fraction inhaled oxygen, oxygen saturation, and tidal volumes were compared between groups.

Results

A total of 1,286 patients met criteria for inclusion; 242 had a diagnosis of ALI preoperatively. Comparison of patients with ALI versus those without ALI found statistically yet clinically insignificant differences between the ventilation strategies between the groups in peak inspiratory pressures and positive end-expiratory pressure but no other category. The tidal volumes in cc/kg predicted body weight were approximately 8.7 in both groups. Peak inspiratory pressures were found to be 27.87 cm H₂O on average in the non-ALI group and 29.2 in the ALI group.

Conclusion

Similar ventilation strategies are used between patients with ALI and those without ALI. These findings suggest that anesthesiologists are not using lung protective ventilation strategies when ventilating patients with low Paco₂/Fio₂ ratios and ALI, and instead are treating hypoxia and ALI with higher concentrations of oxygen and peak pressures (Figs 2, Tables 4 and 5).

Figure 2 (A–D) Distribution of ventilator settings by ALI status. (A) cc of ventilation per kg PBW by ALI status. Solid lines represent median values, boxes represent the interquartile range, T bars represent 95% of total sample, represent outliers (1.5–3 X box length), ^* represent extreme outliers (more than 3 X box length). (B) Median positive end-expiratory pressure (PEEP) by ALI status. Solid lines represent median values, boxes represent the interquartile range, T bars represent 95% of total sample, represent outliers (1.5–3 X box length), ^* represent extreme outliers (more than 3 X box length). (C) Median PIP by ALI status. Solid lines represent median values, boxes represent the interquartile range, T bars represent 95% of total sample, represent outliers (1.5–3 X box length), ^* represent extreme outliers (more than three times box length). (D) Median Fio₂ by ALI status. Solid lines represent median values, boxes represent the interquartile range, T bars represent 95% of total sample, represent outliers (1.5–3 X box length), ^* represents extreme outliers (more than 3 X box length). ALI = acute lung injury; Fio₂ = fraction inspired oxygen; PBW = predicted body weight; PEEP = positive end expiratory pressure; PIP = peak inspiratory pressure. (Reprinted from Blum JM, Maile M, Park PK, et al. A description of intraoperative ventilator management in patients with acute lung injury and the use of lung protective ventilation strategies. Anesthesiology. 2011;115:75-82, with permission from the American Society of Anesthesiologists, Inc.)

Only gold members can continue reading. Log In or Register to continue

Share this:

• Click to share on Twitter (Opens in new window)
• Click to share on Facebook (Opens in new window)

Related

Related posts:

of change in daily step count over five years with insulin sensitivity and adiposity: population based cohort study of Cancer: The Next Generation Beverages and Risk of Metabolic Syndrome and Type 2 Diabetes: A meta-analysis time and haemodynamic response after thiopental vs. propofol in the elderly: a randomized trial monitoring of neuromuscular block over the orbicularis oris muscle in anesthetized patients receiving vecuronium Is Better Than General Anesthesia During Endovascular Acute Stroke Interventions