Normal tidal volume per kilogram9/11/2023 ![]() 13Based on these data, it seems justified to request protective ventilator strategies in risk patients routinely and not to wait until the ALI or ARDS criteria are fulfilled. 12Recent surveys demonstrated that V Tin critically ill patients is on average approximately 7–8 ml/kg BW but that still V Tbetween 12 and 18 ml/kg BW are used with low or nil PEEP. In an international cohort of unselected ARDS patients, neither P platnor V Tbut use of low or no PEEP was associated with adjusted mortality. 10,11It is of importance that these analyses included patients who were critically ill and had obviously either cardiopulmonary disease or ventilatory dysfunction and had thus per se a certain risk to develop ALI or ARDS. 8,9Two retrospective analyses identified high airway pressures and V Tas independent risk factors for development of ALI and ARDS in patients requiring MV for acute respiratory failure. argue that in critically ill patients requiring MV for pulmonary edema, chronic obstructive pulmonary disease, congestive heart failure, aspiration, pneumonia, and trauma and after surgery not fulfilling ARDS criteria, mortality is associated with application of high V Tand P plat. 8suggest the use of low V Tventilation with PEEP levels above 5 cm H 2O in patients without ALI or ARDS in absence of large-scale prospective randomized trials. 7In this issue of Anesthesiology, Schultz et al. A secondary analysis of the ARDS Network database showed a beneficial effect of V Treduction from 12 ml/kg to 6 ml/kg PBW even in patients with low P platranging between 16 and 26 cm H 2O before V Treduction. 6The lack of effect of higher PEEP levels was partially explained by the resulting higher P plat. 3–5Using V Tof not more than 6 ml/kg PBW comparing a high positive end-expiratory pressure (PEEP)–low inspiratory oxygen fraction (Fio 2) with a low PEEP–high Fio 2strategy to prevent hypoxemia did not demonstrate advantageous of higher PEEP levels in ALI and ARDS patients. 1However, decreasing V Tdid not improve outcome in three other controlled trials investing V Tin ALI and ARDS patients, which was explained by differences in study design ( table 1). 1,2In the low V Tgroup, V Twas reduced further to 5 or 4 ml/kg PBW if necessary to maintain plateau pressure (P plat) at less than 30 cm H 2O. ![]() ![]() ![]() MECHANICAL ventilation (MV) using tidal volumes (V T) of not more than 6 ml/kg predicted body weight (PBW) has been shown to result in reduction of systemic inflammatory markers, increased ventilator-free days, and reduction in mortality when compared with V Tof 12 ml/kg PBW in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) ( table 1). ![]()
0 Comments
Leave a Reply.AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |