Risk factors for underuse of lung-protective ventilation in acute lung injury

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• 作者：Allan J. Walkey ; MD ; MSc^a ; ^{alwalkey@bu.edu} ; Renda Soylemez Wiener ; MD ; MPH^a ; ^b ; ^c ; ^{rwiener@bu.edu}
• 关键词：Acute lung injury ; Risk factors ; Quality improvement
• 刊名：Journal of Critical Care
• 出版年：2012
• 期刊代码：167_08839441
• 类别：med
• 出版时间：June, 2012
• 卷：27
• 期：3
• 页码：323.e1-323.e9
• 文件大小：380 K

摘要

Purpose

We assessed factors associated with underuse of lung-protective ventilation (LPV) in patients with acute lung injury (ALI).

Methods

A secondary analysis of Acute Respiratory Distress Syndrome Clinical Trials Network trial data, 1999 to 2005, was conducted. Tidal volumes recorded before trial randomization were analyzed to determine receipt of LPV (tidal volume 鈮?.5 mL/kg of predicted body weight [PBW]).

Results

Of 1385 participants, 430 (31.2%) received LPV. Average tidal volume was 7.65 卤 1.82 mL/kg PBW; measured tidal volumes were greater than 鈥渓ung-protective鈥?tidal volumes predicted by 6.5 mL/kg PBW (mean difference, 67 卤 108 mL; P < .0001). Multivariate predictors of LPV underuse were older age (odds ratio [OR] per SD year, 1.18; 95%confidence interval [CI], 1.02-1.38), white race (OR, 1.40; 95%CI, 1.05-1.88), shorter stature (OR per SD centimeter, 0.55; 95%CI, 0.48-0.63), lower Simplified Acute Physiology II Score (OR per SD, 0.78; 95%CI, 0.67-0.92), lower lung injury score (OR per SD, 0.83; 95%CI, 0.70-0.95), decreased serum bicarbonate (OR per SD mmol/L, 0.83; 95%CI, 0.71-0.97), shorter preenrollment intensive care unit stay (OR per SD day, 0.84; 95%CI, 0.73-0.98), and use of non-volume-controlled ventilation (OR, 3.07; 95%CI, 1.78-5.27). Setting tidal volumes to 450 mL (men) or 350 mL (women) would provide LPV to 80%of patients with ALI.

Conclusions

Simple interventions could substantially improve adherence with LPV among patients with ALI and warrant prospective study.