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Low Tidal Volume Ventilation in Patients without Acute Respiratory Distress Syndrome: A Paradigm Shift in Mechanical Ventilation.

Lipes J, Bojmehrani A, Lellouche F - Crit Care Res Pract (2012)

Bottom Line: Protective ventilation with low tidal volume has been shown to reduce morbidity and mortality in patients suffering from acute lung injury (ALI) and acute respiratory distress syndrome (ARDS).Low tidal volume ventilation is associated with particular clinical challenges and is therefore often underutilized as a therapeutic option in clinical practice.In addition, we will explore some of the potential reasons for its underuse and provide strategies to overcome some of the associated clinical challenges.

View Article: PubMed Central - PubMed

Affiliation: Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Quebec, QC, Canada G1V 4G5.

ABSTRACT
Protective ventilation with low tidal volume has been shown to reduce morbidity and mortality in patients suffering from acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Low tidal volume ventilation is associated with particular clinical challenges and is therefore often underutilized as a therapeutic option in clinical practice. Despite some potential difficulties, data have been published examining the application of protective ventilation in patients without lung injury. We will briefly review the physiologic rationale for low tidal volume ventilation and explore the current evidence for protective ventilation in patients without lung injury. In addition, we will explore some of the potential reasons for its underuse and provide strategies to overcome some of the associated clinical challenges.

No MeSH data available.


Related in: MedlinePlus

iAnthropometer II smartphone application for the assessment of PBW [113]. This smartphone application facilitates the calculation of patient height via digital measurement of leg length and subsequently calculates the PBW and the appropriate corresponding VT.
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fig1: iAnthropometer II smartphone application for the assessment of PBW [113]. This smartphone application facilitates the calculation of patient height via digital measurement of leg length and subsequently calculates the PBW and the appropriate corresponding VT.

Mentions: Even when ICU physicians attempt to use protective ventilation in their everyday practice, the use of actual instead of PBW in the calculation of VT is a frequent error, leading to overtreatment with higher VTs. PBW in men is calculated as 50 (45 in women) + 0.91 (Height cm −152.4) [11]. In many instances, the height of the patient is not immediately known. This is especially true outside of the surgical ICU (i.e., emergency department, postanesthesia recovery room or medical ICU) because surgical ICUs are more likely to have height and weight measurements due to the operative record [58]. In addition, visual estimation of patient height and weight is known to be inaccurate [109–111], and shorter patients, often women, tend to be more severely affected [54, 112]. The ability to rapidly calculate PBW at the bedside is important. Novel devices such as applications on smartphones, (e.g., iAnthropometer ICU), where one can quickly take a bedside picture of a patients leg and calculate the patients height based on validated formulas, and automatically derive the PBW and subsequent VTs, are promising tools (Figure 1) [113]. This application was more accurate at calculating patient height than both the method of visual estimation and supine in-bed tape measurement [114].


Low Tidal Volume Ventilation in Patients without Acute Respiratory Distress Syndrome: A Paradigm Shift in Mechanical Ventilation.

Lipes J, Bojmehrani A, Lellouche F - Crit Care Res Pract (2012)

iAnthropometer II smartphone application for the assessment of PBW [113]. This smartphone application facilitates the calculation of patient height via digital measurement of leg length and subsequently calculates the PBW and the appropriate corresponding VT.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3318889&req=5

fig1: iAnthropometer II smartphone application for the assessment of PBW [113]. This smartphone application facilitates the calculation of patient height via digital measurement of leg length and subsequently calculates the PBW and the appropriate corresponding VT.
Mentions: Even when ICU physicians attempt to use protective ventilation in their everyday practice, the use of actual instead of PBW in the calculation of VT is a frequent error, leading to overtreatment with higher VTs. PBW in men is calculated as 50 (45 in women) + 0.91 (Height cm −152.4) [11]. In many instances, the height of the patient is not immediately known. This is especially true outside of the surgical ICU (i.e., emergency department, postanesthesia recovery room or medical ICU) because surgical ICUs are more likely to have height and weight measurements due to the operative record [58]. In addition, visual estimation of patient height and weight is known to be inaccurate [109–111], and shorter patients, often women, tend to be more severely affected [54, 112]. The ability to rapidly calculate PBW at the bedside is important. Novel devices such as applications on smartphones, (e.g., iAnthropometer ICU), where one can quickly take a bedside picture of a patients leg and calculate the patients height based on validated formulas, and automatically derive the PBW and subsequent VTs, are promising tools (Figure 1) [113]. This application was more accurate at calculating patient height than both the method of visual estimation and supine in-bed tape measurement [114].

Bottom Line: Protective ventilation with low tidal volume has been shown to reduce morbidity and mortality in patients suffering from acute lung injury (ALI) and acute respiratory distress syndrome (ARDS).Low tidal volume ventilation is associated with particular clinical challenges and is therefore often underutilized as a therapeutic option in clinical practice.In addition, we will explore some of the potential reasons for its underuse and provide strategies to overcome some of the associated clinical challenges.

View Article: PubMed Central - PubMed

Affiliation: Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Quebec, QC, Canada G1V 4G5.

ABSTRACT
Protective ventilation with low tidal volume has been shown to reduce morbidity and mortality in patients suffering from acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Low tidal volume ventilation is associated with particular clinical challenges and is therefore often underutilized as a therapeutic option in clinical practice. Despite some potential difficulties, data have been published examining the application of protective ventilation in patients without lung injury. We will briefly review the physiologic rationale for low tidal volume ventilation and explore the current evidence for protective ventilation in patients without lung injury. In addition, we will explore some of the potential reasons for its underuse and provide strategies to overcome some of the associated clinical challenges.

No MeSH data available.


Related in: MedlinePlus