A multicentre observational study of intra‐operative ventilatory management during general anaesthesia: tidal volumes and relation to body weight

Jaber, Samir; Coisel, Yannaël; Chanques, Gérald; Futier, Emmanuel; Constantin, Jean-Michel; Michelet, Pierre; Beaussier, Marc; Lefrant, Jean‐Yves; Allaouchiche, Bernard; Capdevila, Xavier; Marret, Emmanuel

doi:10.1111/j.1365-2044.2012.07218.x

Cited by 143 publications

(109 citation statements)

References 43 publications

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“…Our data help explain, in part, why women frequently receive higher V T compared with men. 7,8,11,12,30,36 These data highlight the importance of height in effectively reducing V T , which may be difficult when accurate height measurements are not available. Consequently, finding an accurate and easy method to obtain height measurements in bedridden patients is of great importance.…”

Section: Potential Impact On Implementation Of Protective Ventilationmentioning

confidence: 97%

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Comparison of Usual and Alternative Methods to Measure Height in Mechanically Ventilated Patients: Potential Impact on Protective Ventilation

et al. 2013

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BACKGROUND: Protective ventilation implementation requires the calculation of predicted body weight (PBW), determined by a formula based on gender and height. Consequently, height inaccuracy may be a limiting factor to correctly set tidal volumes. The objective of this study was to evaluate the accuracy of different methods in measuring heights in mechanically ventilated patients. METHODS: Before cardiac surgery, actual height was measured with a height gauge while subjects were standing upright (reference method); the height was also estimated by alternative methods based on lower leg and forearm measurements. After cardiac surgery, upon ICU admission, a subject's height was visually estimated by a clinician and then measured with a tape measure while the subject was supine and undergoing mechanical ventilation. RESULTS: One hundred subjects (75 men, 25 women) were prospectively included. Mean PBW was 61.0 ؎ 9.7 kg, and mean actual weight was 30.3% higher. In comparison with the reference method, estimating the height visually and using the tape measure were less accurate than both lower leg and forearm measurements. Errors above 10% in calculating the PBW were present in 25 and 40 subjects when the tape measure or visual estimation of height was used in the formula, respectively. With lower leg and forearm measurements, 15 subjects had errors above 10% (P < .001). CONCLUSIONS: Our results demonstrate that significant variability exists between the different methods used to measure height in bedridden patients on mechanical ventilation. Alternative methods based on lower leg and forearm measurements are potentially interesting solutions to facilitate the accurate application of protective ventilation.

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Section: Potential Impact On Implementation Of Protective Ventilationmentioning

confidence: 97%

“…8,10 The use of actual body weight can lead to large errors in V T settings, 11 especially in women and obese patients. 8,12 Visual estimation of the patient's height is frequently used in mechanically ventilated patients. 13,14 However, visual estimation of height and, even more so, of PBW can be inaccurate.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Usual and Alternative Methods to Measure Height in Mechanically Ventilated Patients: Potential Impact on Protective Ventilation

et al. 2013

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“…28 Despite the publication of the ARDSNet landmark paper in 2000 showing that lower V T resulted in a mortality benefit as compared with the traditional V T of 12 m/kg PBW, this strategy has been slow to be employed in the surgical arena. 29 However, over the past decade, there have been encouraging indications that lung-protective ventilation is being used more frequently in the operating room. 30 Since many surgical procedures are of relatively short duration, the focus on lung-protective ventilation is placed on the back burner by many anesthesiologists.…”

Section: Ventilation Of Surgical Patientsmentioning

confidence: 99%

Should A Tidal Volume of 6 mL/kg Be Used in All Patients?

2016

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It has been shown that mechanical ventilation by itself can cause lung injury and affect outcomes. Ventilator-induced lung injury is associated with high tidal volumes in lungs afflicted with ARDS. However, the question is: Do high tidal volumes have this same effect in normal lungs or lungs that have respiratory compromise stemming from something other than ARDS? Many clinicians believe that a tidal volume strategy of 6 mL/kg predicted body weight should be standard practice in all patients receiving mechanical ventilation. There is a growing body of evidence related to this issue, and this is the debate that will be tackled in this paper from both pro and con perspectives. Key words: tidal volume; predicted body weight; mechanical ventilation; lung-protective ventilation; time constant; ARDS; stress; strain; hypercapnia. [Respir Care 2016;61(6):774 -790 . © 2016 Daedalus Enterprises] IntroductionIt is well known that the use of mechanical ventilation has the potential to aggravate pulmonary injury, but emerging evidence indicates that it may also precipitate lung injury in patients with no previous injury. Lung-protective ventilation has evolved over the past couple of decades to the point that it has become standard of care for patients with ARDS. The use of lower tidal volume (V T ) 4 -8 mL/kg predicted body weight (PBW) is part of this lung-protective strategy for mechanical ventilation (mechanical ventilation) along with limiting the plateau pressure to a maximum of 30 cm H 2 O and prudent use of PEEP to prevent atelectasis. Since we now know that the use of lower V T strategies (more specifically 6 mL/kg PBW) helps to limit the pulmonary damage during ARDS, the question now is: Should we be using this strategy in all mechanically ventilated patients? Anatomically speaking, it makes sense to, since the normal physiologic V T for humans is approximately 6 mL/kg PBW. 1 There is a growing body of evidence that points toward the use of lower V T values leading to improved outcomes in patients suffering from other forms and degrees of respiratory failure. The aim of this paper is to examine the evidence relating to the use of lower V T values in conditions other than ARDS in which mechanical ventilation is required. This will be done with viewpoints from both the pro and con positions. Early StudiesThere is a plethora of preclinical evidence from animal studies supporting the fact that the use of high V T values can directly cause injury to normal lungs. Animal studies have shown that high V T ventilation increases levels of pro-inflammatory mediators, leads to pulmonary edema, and causes increased alveolar-capillary permeability and structural abnormalities. [2][3][4][5][6][7][8] With the emergence of these animal data, clinicians began to question the traditional use of V T values in the range of 10 -15 mL/kg PBW in humans. Several small human studies were reported in the mid-to late 1990s that produced conflicting results. 9-11 These studies were hampered by several factors, including higher than predicte...

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“…Jaber et al 33 conducted a multicentre, observational study to describe intraoperative ventilatory practices to determine the incidence of the use of large intraoperative VTs (≥10 ml/kg of ideal body weight [IBW]) and to identify patient specific risk factors associated with this practice. They studied 2960 patients in 97 anaesthetic units in 49 hospitals.…”

Section: Pathophysiological Eff Ects Of Intraoperative Lung-protectivmentioning

confidence: 99%

Lung protective ventilation strategies in routine anaesthetic practice: ready for prime time?

Toth-Tarsoly¹,

Szakmány²

2013

OA Anaesthetics

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A multicentre observational study of intra‐operative ventilatory management during general anaesthesia: tidal volumes and relation to body weight

Cited by 143 publications

References 43 publications

Comparison of Usual and Alternative Methods to Measure Height in Mechanically Ventilated Patients: Potential Impact on Protective Ventilation

Comparison of Usual and Alternative Methods to Measure Height in Mechanically Ventilated Patients: Potential Impact on Protective Ventilation

Should A Tidal Volume of 6 mL/kg Be Used in All Patients?

Lung protective ventilation strategies in routine anaesthetic practice: ready for prime time?

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