Description of Intraoperative Ventilator Management in Patients with Acute Lung Injury and the Use of Lung Protective Ventilation Strategies

Critical Care Medicine


Adult Critical Care


A Description of Intraoperative Ventilator Management in Patients with Acute Lung Injury and the Use of Lung Protective Ventilation Strategies


Blum JM, Maile M, Park PK, et al (Univ of Michigan Health System, Ann Arbor) Anesthesiology 115:75-82, 2011§



M. Mathru, MD



Evidence Ranking


• C



Expert Rating


• 2



Abstract






Conclusion


Similar ventilation strategies are used between patients with ALI and those without ALI. These findings suggest that anesthesiologists are not using lung protective ventilation strategies when ventilating patients with low Paco2/Fio2 ratios and ALI, and instead are treating hypoxia and ALI with higher concentrations of oxygen and peak pressures (Figs 2, Tables 4 and 5).


image

Figure 2 (A–D) Distribution of ventilator settings by ALI status. (A) cc of ventilation per kg PBW by ALI status. Solid lines represent median values, boxes represent the interquartile range, T bars represent 95% of total sample, image represent outliers (1.5–3 X box length), * represent extreme outliers (more than 3 X box length). (B) Median positive end-expiratory pressure (PEEP) by ALI status. Solid lines represent median values, boxes represent the interquartile range, T bars represent 95% of total sample, image represent outliers (1.5–3 X box length), * represent extreme outliers (more than 3 X box length). (C) Median PIP by ALI status. Solid lines represent median values, boxes represent the interquartile range, T bars represent 95% of total sample, image represent outliers (1.5–3 X box length), * represent extreme outliers (more than three times box length). (D) Median Fio2 by ALI status. Solid lines represent median values, boxes represent the interquartile range, T bars represent 95% of total sample, image represent outliers (1.5–3 X box length), * represents extreme outliers (more than 3 X box length). ALI = acute lung injury; Fio2 = fraction inspired oxygen; PBW = predicted body weight; PEEP = positive end expiratory pressure; PIP = peak inspiratory pressure. (Reprinted from Blum JM, Maile M, Park PK, et al. A description of intraoperative ventilator management in patients with acute lung injury and the use of lung protective ventilation strategies. Anesthesiology. 2011;115:75-82, with permission from the American Society of Anesthesiologists, Inc.)

Jan 28, 2017 | Posted by in ANESTHESIA | Comments Off on Description of Intraoperative Ventilator Management in Patients with Acute Lung Injury and the Use of Lung Protective Ventilation Strategies
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