Accurate Tidal Volume for Patients under Mechanical Ventilation: A Cross-sectional Descriptive Study

Background: In order to prevent lung injury among patients under mechanical ventilation, tidal volume should be determined based on predicted body weight. The aim of the study was to determine the accuracy of tidal volume determination for patients under mechanical ventilation and to assess nurses’ knowledge about accurate tidal volume determination. Methods: This was a cross-sectional descriptive study. This study was conducted on 250 patients under mechanical ventilation and 75 nurses who provided care to the patients. Patients’ height was estimated based on their ulna length and then, their predicted body weight and tidal volume were estimated. Nurses’ knowledge about tidal volume determination was also assessed. Results: The mean of delivered tidal volume was 9.1±1.73 mL/kg of predicted body weight. Tidal volume for 172 patients (68.8%) had been set at more than 8 mL/kg of predicted body weight. Forty nine nurses (65.3%) noted that there was no guideline in their wards for height and weight measurement. They determined patients’ weight and height through either visual estimation (21 nurses; 28.0%) or asking from their colleagues, patients, or patients’ family members (48 nurses; 64.0%). Conclusion: Nurses have limited knowledge about accurate tidal volume determination and hence, deliver high tidal volume to patients under mechanical ventilation which puts them at risk for ventilator-associated lung injury. Urgent interventions such as lung-protective strategies, staff training, and careful managerial supervision are needed to prevent ventilator-associated lung injury and improve patient safety.

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Effects of Feedback and Education on Nurses’ Clinical Competence in Mechanical Ventilation and Accurate Tidal Volume Setting

Journal of Iranian Medical Council ◽

10.18502/jimc.v4i1.5740 ◽

2021 ◽

Author(s):

Samira Norouzrajabi ◽

Shahrzad Ghiyasvandian ◽

Alireza Jeddian ◽

Ali Karimi Rozveh ◽

Leila Sayadi

Keyword(s):

Mechanical Ventilation ◽

Body Weight ◽

Tidal Volume ◽

Clinical Competence ◽

High Tidal Volume ◽

Education Intervention ◽

Predicted Body Weight ◽

Post Test ◽

The Mean ◽

Effects Of Feedback

Background: Patients under mechanical ventilation are at risk of ventilator-associated complications. One of these complications is lung injury due to high tidal volume. Nurses’ competence in mechanical ventilation is critical for preventing ventilator-associated complications. This study assessed the effects of feedback and education on nurses’ clinical competence in mechanical ventilation and accurate tidal volume setting. Methods: This single arm pretest-post-test interventional study was conducted in 2019 at Shariati hospital affiliated to Tehran University of Medical Sciences. Participants were 75 conveniently selected nurses. Initially, nurses’ clinical competence in mechanical ventilation and ventilator parameters of 250 patients were assessed. A mechanical ventilation -based feedback and education intervention was implemented for nurses. Finally, mechanical ventilation clinical competence of nurses and ventilator parameters of 250 new patients were assessed. Moreover, patients’ height was estimated based on their ulna length and then, their predicted body weight was calculated using their estimated height. Accurate tidal volume was determined per predicted body weight. Results: The mean score of nurses’ clinical competence increased from 8.27±3.09 at pretest to 10.07±3.34 at post-test (p<0.001). The mean values of both total tidal volume and tidal volume per kilogram of predicted body weight were significantly reduced respectively from 529.84±69.11 and 9.11±1.73 (ml) at pretest to 476.30±31.01 and 7.79±1.14 (ml) at post-test (p<0.001). Conclusion: The feedback and education intervention is effective in promoting nurses’ clinical competence in mechanical ventilation and reducing tidal volume. Thereby, it can reduce lung injuries associated with high tidal volume and ensure patient safety.

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Tidal Volume, Predicted Body Weight, and Modes of Mechanical Ventilation

CHEST Journal ◽

10.1016/j.chest.2016.08.335 ◽

2016 ◽

Vol 150 (4) ◽

pp. 322A

Author(s):

Keith Lamb ◽

Trevor Oetting ◽

Julie Jackson ◽

Gregory Hicklin

Keyword(s):

Mechanical Ventilation ◽

Body Weight ◽

Tidal Volume ◽

Predicted Body Weight

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Pre-treatment with Isoflurane or Sevoflurane is not protective against high tidal volume induced lung injury in rats

10.21203/rs.2.13334/v1 ◽

2019 ◽

Author(s):

Florian Setzer ◽

Lars Hueter ◽

Barbara Schmidt ◽

Konrad Schwarzkopf ◽

Torsten Schreiber

Keyword(s):

Mechanical Ventilation ◽

Body Weight ◽

Lung Injury ◽

Tidal Volume ◽

Lavage Fluid ◽

Lung Lavage ◽

Protective Effects ◽

Markers Of Inflammation ◽

In Vivo Animal Model

Abstract Background Volatile anesthetics (VA) may exert organ-protective effects in various experimental and clinical settings. Mechanical ventilation (MV) induces an inflammatory response and, depending on the ventilator settings chosen, injury in the lungs. It is unclear if prophylactic inhaled VA applied on healthy lungs prior to MV are protective regarding these effects.Methods Healthy, spontaneously breathing rats were exposed for 30 minutes to either isoflurane (1.8 Vol %), sevoflurane (3.0 Vol %) or no VA (controls). Animals were allowed to recover and then mechanically ventilated for 4 hours with either high (21 ml/kg body weight) or low (9 ml/kg body weight) tidal volume. Cardiorespiratory parameters and systemic inflammation were assessed at the beginning and during mechanical ventilation. Cellular, non-cellular and histologic markers of pulmonary injury and inflammation were determined.Results Irrespective of VA pretreatment, MV with high VT negatively affected markers of lung integrity such as arterial oxygenation and lung wet-to-dry ratio. Regarding the application of VA pretreatment protective effects on lung function were absent but there were changes in some markers of inflammation such as a decrease in blood lymphocyte counts and an increase in interleukin 6 concentration in plasma and in lung lavage fluid. These effects were heterogeneous regarding group allocation and time points.Conclusions In this in in vivo animal model, prophylactic administration of inhaled VA was not beneficial or protective regarding ventilation induced lung injury. However, there were effects suggestive of a modulation of inflammatory markers associated with VA prophylaxis. The clinical or biological relevance of these findings so far remain unclear and should be subject to further studies.

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High Tidal Volumes in Mechanically Ventilated Patients Increase Organ Dysfunction after Cardiac Surgery

Anesthesiology ◽

10.1097/aln.0b013e3182522df5 ◽

2012 ◽

Vol 116 (5) ◽

pp. 1072-1082 ◽

Cited By ~ 147

Author(s):

François Lellouche ◽

Stéphanie Dionne ◽

Serge Simard ◽

Jean Bussières ◽

François Dagenais

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Body Weight ◽

Cardiac Surgery ◽

Intensive Care ◽

Lung Injury ◽

Tidal Volume ◽

Organ Failure ◽

Predicted Body Weight ◽

Prolonged Stay

Background High tidal volumes in patients with acute respiratory distress syndrome and acute lung injury lead to ventilator-induced lung injury and increased mortality. We evaluated the impact of tidal volumes on cardiac surgery outcomes. Methods We examined prospectively recorded data from 3,434 consecutive adult patients who underwent cardiac surgery. Three groups of patients were defined based on the tidal volume delivered on arrival at the intensive care unit: (1) low: below 10, (2) traditional: 10-12, and (3) high: more than 12 ml/kg of predicted body weight. We assessed risk factors for three types of organ failure (prolonged mechanical ventilation, hemodynamic instability, and renal failure) and a prolonged stay in the intensive care unit. Results The mean tidal volume/actual weight was 9.2 ml/kg, and the tidal volume/predicted body weight was 11.5 ml/kg. Low, traditional, and high tidal volumes were used in 724 (21.1%), 1567 (45.6%), and 1,143 patients (33.3%), respectively. Independent risks factors for high tidal volumes were body mass index of 30 or more (odds ratio [OR] 6.25; CI: 5.26-7.42; P < 0.001) and female sex (OR 4.33; CI: 3.64-5.15; P < 0.001). In the multivariate analysis, high and traditional tidal volumes were independent risk factors for organ failure, multiple organ failure, and prolonged stay in the intensive care unit. Organ failures were associated with increased intensive care unit stay, hospital mortality, and long-term mortality. Conclusion Tidal volumes of more than 10 ml/kg are risk factors for organ failure and prolonged intensive care unit stay after cardiac surgery. Women and obese patients are particularly at risk of being ventilated with injurious tidal volumes.

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A Higher Tidal Volume May Be Used for Athletes according to Measured FVC

The Scientific World JOURNAL ◽

10.1155/2013/526138 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Pavlos Myrianthefs ◽

George Baltopoulos

Keyword(s):

Mechanical Ventilation ◽

Body Weight ◽

Tidal Volume ◽

Vital Capacity ◽

Professional Athletes ◽

Normal Lung ◽

Predicted Body Weight ◽

Lung Volumes ◽

Males And Females ◽

The Difference

We investigated whether professional athletes may require higher tidal volume (Tv) during mechanical ventilation hypothesizing that they have significantly higher “normal” lung volumes compared to what was predicted and to nonathletes. Measured and predicted spirometric values were recorded in both athletes and nonathletes using a Spirovit SP-1 spirometer (Schiller, Switzerland). NormalTv(6 mL/kg of predicted body weight) was calculated as a percentage of measured and predicted forced vital capacity (FVC) and the difference (δ) was used to calculate the additionalTvrequired using the equation: NewTv(TvN)=Tv+(Tv×δ). Professional athletes had significantly higher FVC compared to what was predicted (by 9% in females and 10% in males) and to nonathletes. They may also require aTvof 6.6 mL/kg for males and 6.5 mL/kg for females during mechanical ventilation. Nonathletes may require aTvof 5.8 ± 0.1 mL/kg and 6.3 ± 0.1 mL/kg for males and females, respectively. Our findings show that athletes may require additionalTvof 10% (0.6/6 mL/kg) for males and 8.3% (0.5/6 mL/kg) for females during general anesthesia and critical care which needs to be further investigated and tested.

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Tidal Volume in Mechanical Ventilation: The Importance of Considering Predicted Body Weight

American Journal of Respiratory and Critical Care Medicine ◽

10.1164/ajrccm.178.3.315 ◽

2008 ◽

Vol 178 (3) ◽

pp. 315-316 ◽

Cited By ~ 1

Author(s):

Andreas Günther ◽

Friedemann Taut

Keyword(s):

Mechanical Ventilation ◽

Body Weight ◽

Tidal Volume ◽

Predicted Body Weight

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A single, 30 minutes pretreatment with Isoflurane or Sevoflurane is not protective against high tidal volume induced lung injury in rats

10.21203/rs.2.13334/v2 ◽

2020 ◽

Author(s):

Florian Setzer ◽

Lars Hueter ◽

Barbara Schmidt ◽

Konrad Schwarzkopf ◽

Torsten Schreiber

Keyword(s):

Mechanical Ventilation ◽

Body Weight ◽

Lung Injury ◽

Tidal Volume ◽

Lavage Fluid ◽

Lung Lavage ◽

Protective Effects ◽

Markers Of Inflammation ◽

In Vivo Animal Model

Abstract Background: Volatile anesthetics (VA) may exert organ-protective effects in various experimental and clinical settings. Mechanical ventilation (MV) induces an inflammatory response and, depending on the ventilator settings chosen, injury in the lungs. It is unclear if prophylactic inhaled VA applied on healthy lungs prior to MV are protective regarding these effects. Methods: Healthy, spontaneously breathing rats were exposed for 30 minutes to either isoflurane (1.8 Vol %), sevoflurane (3.0 Vol %) or no VA. Animals were allowed to recover, intraperitoneally anesthetized and then mechanically ventilated for 4 hours with either high (21 ml/kg body weight) or low (9 ml/kg body weight) tidal volume (n = 12 per group). Cardiorespiratory parameters and systemic inflammation were assessed at the beginning and during mechanical ventilation. Cellular, non-cellular and histologic markers of pulmonary injury and inflammation were determined. Results: Irrespective of VA pretreatment, MV with high VT negatively affected markers of lung integrity such as arterial oxygenation and lung wet-to-dry ratio. Following VA pretreatment we found no protective effects on lung function but there were changes in some markers of inflammation such as a decrease in blood lymphocyte counts and an increase in interleukin 6 concentration in plasma and lung lavage fluid. These effects were heterogeneous regarding group allocation and time points. Conclusions: In this in in vivo animal model, prophylactic administration of inhaled VA was not beneficial or protective regarding ventilation induced lung injury. However, there were effects suggestive of a modulation of inflammatory markers associated with VA prophylaxis. The clinical or biological relevance of these findings so far remain unclear and should be subject to further studies.

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