1025: Adherence to ≤ 8 Milliliters Tidal Volume per Ideal Body Weight in Mechanically Ventilated Patients

2020 ◽  
Vol 49 (1) ◽  
pp. 511-511
Author(s):  
Andrew Goodrich ◽  
Ulrich Schmidt ◽  
Albert Nguyen
Keyword(s):  
Body Weight ◽  
Tidal Volume ◽  
Ideal Body Weight ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ideal Body ◽  
Ventilated Patients

Comparison of Predicted and Measured Energy Expenditure in Mechanically Ventilated Obese Patients

1995 ◽  
Vol 11 (2) ◽  
pp. 47-49 ◽  
Author(s):  
Helen M. O'Connell ◽  
Brian L. Erstad
Keyword(s):  
Body Weight ◽  
Medical Center ◽  
Ideal Body Weight ◽  
Obese Patients ◽  
Mechanically Ventilated ◽  
Measured Energy ◽  
Ideal Body ◽  
Mean Differences ◽  
Caloric Requirements ◽  
Ventilated Patients

Objective: To test the appropriateness of using actual body weight (ABW), ideal body weight (IBW), or an adjusted weight for predicting caloric requirements in moderately obese, mechanically ventilated patients receiving parenteral or enteral nutrition. Design: Prospective, nonrandomized pilot study involving seven patients. Setting: University medical center. Main Outcome Measures: Predicted caloric requirements based on ABW, IBW, or an adjusted weight were compared with measured requirements by indirect calorimetry after parenteral nutrition or tube feedings were at goal rate for 24–72 hours. Results: Mean differences between predicted and measured energy requirements for ABW, IBW, and adjusted weight were 821 ± 556 (p < 0.05), −256 ± 493, and 182 ± 501 kcal/d, respectively. Conclusions: Until additional studies are available, IBW or adjusted weight should be used for calculating caloric requirements in the moderately obese patient being mechanically ventilated when actual measurements are not available.

scholarly journals Natural history, trajectory, and management of mechanically ventilated COVID-19 patients in the United Kingdom

2020 ◽  
Author(s):  
Brijesh V Patel ◽  
Shlomi Haar ◽  
Rhodri Handslip ◽  
Teresa Mei-Ling Lee ◽  
Sunil Patel ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Body Weight ◽  
Natural History ◽  
Prone Position ◽  
Invasive Mechanical Ventilation ◽  
Ideal Body Weight ◽  
Evidence Based ◽  
Mechanically Ventilated ◽  
Ideal Body ◽  
Ventilated Patients

AbstractBackgroundTo date the description of mechanically ventilated patients with Coronavirus Disease 2019 (COVID-19) has focussed on admission characteristics with no consideration of the dynamic course of the disease. Here, we present a data-driven analysis of granular, daily data from a representative proportion of patients undergoing invasive mechanical ventilation (IMV) within the United Kingdom (UK) to evaluate the complete natural history of COVID-19.MethodsWe included adult patients undergoing IMV within 48 hours of ICU admission with complete clinical data until intensive care unit (ICU) death or discharge. We examined factors and trajectories that determined disease progression and responsiveness to interventions used in acute respiratory distress syndrome (ARDS). Our data visualisation tool is available as a web-based widget (https://www.CovidUK.ICU).FindingsData for 633 adults with COVID-19 who were mechanically ventilated between 01 March 2020 and 31 August 2020 were analysed. Mortality, intensity of mechanical ventilation and severity of organ injury increased with severity of hypoxaemia. Median PaO2/FiO2 in non-survivors on the day of death was 12.3(8.9-18.4) kPa suggesting severe refractory hypoxaemia as a major contributor to mortality. Non-resolution of hypoxaemia over the first week of IMV was associated with higher ICU mortality (60.4% versus 17.6%; P<0.001). The reported ideal body weight overestimated our calculated ideal body weight derived from reported height, with three-quarters of all reported tidal volume values were above 6mL/kg of ideal body weight. Overall, 76% of patients with moderate hypoxaemia and 46% with severe did not undergo prone position at any stage of admission. Furthermore, only 45% showed a persistent oxygenation response on prone position. Non-responders to prone position show higher lactate, D-Dimers, troponin, cardiovascular component of the sequential organ failure assessment (SOFA) score, and higher ICU mortality (69.5% versus 31.1%; P<0.001). There was no difference in number of prone sessions between survivors and non-survivors, however, patients who died without receiving prone position had a greater number of missed opportunities for prone intervention (7(3-15.5) versus 2(0-6); P<0.001).InterpretationA sizeable proportion of patients with progressive worsening of hypoxaemia had no application of and were refractory to evidence based ARDS strategies and showed a higher mortality. Strategies for early recognition and management of COVID-19 patients refractory to conventional management strategies will be critical to improving future outcomes.Research in contextEvidence before this studyBeyond the regular literature expertise of our consortium, we enhanced our literature review - due to the fast-evolving Covid-19 publication situation-by searching PubMed for articles published in English or with English language abstracts on October 26, 2020 (and before), with the terms “mechanical ventilation”, “prone position”, “AND (“coronavirus” OR “COVID-19”). Studies including patients not receiving ventilation were excluded, as were those reporting on paediatric and single-centre populations. Note, that neither of those studies analysed the data with respect to the temporal evolution of patients and at our level of granularity. Only four multicentre studies reported detailed ventilator settings and outcomes in ventilated patients with COVID-19. All studies showed only ventilator settings with restricted time points either on admission or the first 4 days of admission. None enabled granular visualisation and analysis of longitudinal ICU trajectory and management.Added value of this studyThis study provides a comprehensive analysis and visualisation of routine clinical measurements tracking the whole ICU time course of patients undergoing invasive mechanical ventilation for COVID-19. Mechanically ventilated patients with COVID-19 have a different natural history and trajectory from descriptions of non-COVID ARDS patients, not predictable from admission physiology. Refractory hypoxaemia is an attributable factor associated with poor outcomes in Covid-19 and hence, understanding of use and utility of evidence-based ARDS interventions is clinically crucial. Opportunities to apply prone positioning appropriately are frequently missed, application of high levels of PEEP, and higher tidal volume delivery than planned is common. Lack of responsiveness to advanced ARDS management is associated with hypercoagulation and cardiovascular instability. These data may help homogenise future clinical management protocols and suggest change-of-practice trials.Implications of all the available evidenceThis study shows that disease progression in Covid-19 during the first surge occurred more frequently and for longer than other forms of respiratory failure from pre-Covid19 studies. Furthermore, variations in clinical practise occur across sites which may benefit from standardisation of evidence-based practise. Patients that do not resolve hypoxaemia over the first week have a significantly higher mortality, and, crucially, that a significant proportion are refractory to prone interventions and show variability in responses to PEEP changes. Opportunities to implement prone position were missed in many patients and this was compounded with its reduced effect on oxygenation with delayed application. This lack of responsiveness is related to indices of inflammation, thrombosis, and cardiac dysfunction suggesting that pulmonary thrombosis could influence prone responsiveness and should be pro-actively investigated in the setting of refractory Covid-19 ARDS. Prediction of failure to resolve or respond to ARDS interventions could further focus research on this group with worse outcome.

scholarly journals Use of pressure-regulated volume control in the first 48 hours of hospitalization of mechanically ventilated patients with sepsis or septic shock, with or without ARDS

2019 ◽  
Vol 21 (4) ◽  
pp. 305-311
Author(s):  
Yuri Matusov ◽  
Jing Li ◽  
Dominique Resuello ◽  
Hannah Mathers ◽  
Jeffrey C Fried
Keyword(s):  
Septic Shock ◽  
Distress Syndrome ◽  
Ideal Body Weight ◽  
Volume Control ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Time Points ◽  
Ideal Body ◽  
The Impact ◽  
Ventilated Patients

Purpose To evaluate the impact of pressure-regulated volume control (PRVC/VC+) use on delivered tidal volumes in patients with acute respiratory distress syndrome (ARDS) or at risk for ARDS. Materials and methods Retrospective study of mechanically ventilated adult patients with severe sepsis or septic shock. Results A total of 272 patients were divided into patients with recognized ARDS, patients without ARDS, and patients with unrecognized ARDS. Over 90% of patients were ventilated with PRVC on admission, resulting in delivered tidal volumes significantly higher than set tidal volumes among all groups at all time points, even after ARDS recognition ( p < 0.001). Tidal volumes were lower for patients with pulmonary sepsis as compared to those with a nonpulmonary origin ( p < 0.001). Conclusions Using PRVC promotes augmented delivered tidal volumes, often in excess of 6 mL/kg ideal body weight. Correct recognition of ARDS and having pulmonary sepsis improves compliance with low-stretch protocol ventilation.

scholarly journals Pulmonary Effects of Adjusting Tidal Volume to Actual or Ideal Body Weight in Ventilated Obese Mice

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
Elise Guivarch ◽  
Guillaume Voiriot ◽  
Anahita Rouzé ◽  
Stéphane Kerbrat ◽  
Jeanne Tran Van Nhieu ◽  
...  
Keyword(s):  
Body Weight ◽  
Tidal Volume ◽  
Ideal Body Weight ◽  
Obese Mice ◽  
Ideal Body

scholarly journals Management of hypercapnia in critically ill mechanically ventilated patients—A narrative review of literature

2020 ◽  
Vol 21 (4) ◽  
pp. 327-333
Author(s):  
Ravindranath Tiruvoipati ◽  
Sachin Gupta ◽  
David Pilcher ◽  
Michael Bailey
Keyword(s):  
Mechanical Ventilation ◽  
Tidal Volume ◽  
Dead Space ◽  
Hypercapnic Acidosis ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Low Tidal Volume ◽  
Volume Ventilation ◽  
Low Volume ◽  
Ventilated Patients

The use of lower tidal volume ventilation was shown to improve survival in mechanically ventilated patients with acute lung injury. In some patients this strategy may cause hypercapnic acidosis. A significant body of recent clinical data suggest that hypercapnic acidosis is associated with adverse clinical outcomes including increased hospital mortality. We aimed to review the available treatment options that may be used to manage acute hypercapnic acidosis that may be seen with low tidal volume ventilation. The databases of MEDLINE and EMBASE were searched. Studies including animals or tissues were excluded. We also searched bibliographic references of relevant studies, irrespective of study design with the intention of finding relevant studies to be included in this review. The possible options to treat hypercapnia included optimising the use of low tidal volume mechanical ventilation to enhance carbon dioxide elimination. These include techniques to reduce dead space ventilation, and physiological dead space, use of buffers, airway pressure release ventilation and prone positon ventilation. In patients where hypercapnic acidosis could not be managed with lung protective mechanical ventilation, extracorporeal techniques may be used. Newer, minimally invasive low volume venovenous extracorporeal devices are currently being investigated for managing hypercapnia associated with low and ultra-low volume mechanical ventilation.

Relationship between Cr and breathing pattern in mechanically ventilated patients

1994 ◽  
Vol 77 (6) ◽  
pp. 2703-2708 ◽  
Author(s):  
H. Burnet ◽  
M. Bascou-Bussac ◽  
C. Martin ◽  
Y. Jammes
Keyword(s):  
Linear Regression ◽  
Tidal Volume ◽  
Multiple Linear Regression ◽  
Breathing Pattern ◽  
Minute Ventilation ◽  
Respiratory Frequency ◽  
Upper Airways ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

In mechanically ventilated patients the natural gas-conditioning process of the upper airways is bypassed by the use of an endotracheal tube or a tracheostomy. We hypothesized that under these conditions the breathing pattern may greatly influence the convective respiratory heat loss (Cr). Cr values were computed from minute ventilation (VE) and inspiratory and expiratory gas temperatures, which were measured in six patients under mechanical ventilation for the management of cranial trauma. In each patient the effects of 11–20 different breathing patterns were investigated. Relationships between Cr and VE and between combined tidal volume and respiratory frequency were obtained by simple and multiple linear regression methods, respectively. Comparison of the standard errors of estimate indicated that multiple linear regression gives the best fit. Thus, Cr was highly dependent on the breathing pattern and was not related only to VE. For the same VE value, Cr was higher when VE was achieved with high tidal volume and low respiratory frequency. These data are consistent with previous studies in which thermal exchanges through the upper airways were taxed by hyperventilation of frigid air.

scholarly journals IS SELECTION OF TIDAL VOLUME BASED ON PATIENTS IDEAL BODY WEIGHT?

CHEST Journal ◽  
2020 ◽  
Vol 157 (6) ◽  
pp. A415
Author(s):  
A. Alotaibi ◽  
A. Almajhad ◽  
F. Othman ◽  
T. Ismaeil ◽  
Y. Ismaiel ◽  
...  
Keyword(s):  
Body Weight ◽  
Tidal Volume ◽  
Ideal Body Weight ◽  
Ideal Body ◽  
Selection Of

scholarly journals A Protective Tidal Volume Adapted To Lung Compliance and The PEEP Level With Lowest Transpulmonary Driving Pressure May Be Determined By a Rapid PEEP-Step Procedure

2021 ◽  
Author(s):  
Christina Grivans ◽  
Ola Stenqvist
Keyword(s):  
Body Weight ◽  
Tidal Volume ◽  
Peep Level ◽  
Ideal Body Weight ◽  
Transpulmonary Pressure ◽  
Esophageal Pressure ◽  
Lung Compliance ◽  
Driving Pressure ◽  
Step Procedure ◽  
Ideal Body

Abstract Background: A protective ventilation strategy should be based on lung mechanics and transpulmonary pressure, as this is the pressure that directly “hits” the lung. Esophageal pressure has been used for this purpose but has not gained widespread clinical acceptance. Instead, respiratory system mechanics and airway driving pressure have been used as surrogate measures. We have shown that the lung pressure/volume (P/V) curve coincides with the line connecting the end-expiratory airway P/V points of a PEEP trial. Consequently, transpulmonary pressure increases as much as PEEP and lung compliance (CL) can be determined as ΔEELV/ΔPEEP and transpulmonary driving pressure (ΔPTP) as tidal volume divided by ΔEELV/ΔPEEP.Methods: In ten patients with acute respiratory failure, ΔEELV was measured during each 4 cmH2O PEEP-step from 0 to 16 cmH2O and CL for each PEEP interval calculated as ΔEELV/ΔPEEP giving a lung P/V curve for the whole PEEP trial. Similarily, a lung P/V curve was obtained also for the PEEP levels 8, 12, and 16 cmH2O only.Results: A two-step PEEP procedure starting from a clinical PEEP level of 8 cmH2O gave almost identical lung P/V curves as the four PEEP-step procedure. The lung P/V curves showed a marked individual variation with an over-all CL (CLoa ) 50-137 ml/cmH2O. ΔPTP of a tidal volume of 6-7 ml/kg ideal body weight divided by CLoa ranged from 8.6-2.8 cmH2O, while ΔPTP of tidal volume adapted to CLoa ranged from 3.3 in the patient with lowest to 4.3 cmH 2 O in the patient with highest CLoa . The ratio of airway driving pressure to transpulmonary driving pressure (ΔPTP/ΔPAW) varied between patients and changed with PEEP, reducing the value of ΔPAW as surrogate for ΔPTP in individual patients.Conclusion: Only a two PEEP-step procedure is required for obtaining a lung P/V curve from baseline clinical PEEP to end-inspiration at the highest PEEP level, i.e. without esophageal pressure measurements. The best-fit equation for the curve can be used to determine a tidal volume related to lung compliance instead of ideal body weight and the PEEP level where transpulmonary driving pressure is lowest and possibly least injurious for any given tidal volume.

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