Association between tidal volume size, duration of ventilation, and sedation needs in patients without acute respiratory distress syndrome: an individual patient data meta-analysis

Neto, Ary Serpa; Simonis, Fabienne D.; Barbas, Carmen Sílvia Valente; Biehl, Michelle; Determann, Rogier M.; Elmer, Jonathan; Friedman, Gilberto; Gajic, Ognjen; Goldstein, Joshua N.; Horn, Janneke; Juffermans, Nicole P.; Linko, Rita; Oliveira, Roselaine Pinheiro de; Sundar, Sugantha; Talmor, Daniel; Wolthuis, Esther K.; Abreu, Marcelo Gama de; Pelosi, Paolo; Schultz, Marcus J.

doi:10.1007/s00134-014-3318-4

Cited by 114 publications

(55 citation statements)

References 23 publications

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“…Barotrauma, atelectrauma, volutrauma and biotrauma are all adverse effects of mechanical ventilation 24 . Whereas high quality evidence exists to guide prescription of safe ventilation settings in patients with 25 and without 26 ARDS, there is a dearth of evidence as to the optimal ventilator settings in acute ischemic heart disease. Positive intrathoracic pressure can impact cardiac hemodynamics 27 and reduction in ventilator support can precipitate worsening cardiac ischemia 1 .…”

Section: Discussionmentioning

confidence: 99%

Incidence and Prognostic Impact of Respiratory Support in Patients With ST-Segment Elevation Myocardial Infarction

Metkus

Albaeni

Chandra-Strobos

et al. 2017

The American Journal of Cardiology

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Data addressing the use of respiratory support in acute coronary syndromes are lacking. To address this evidence gap, we characterized prognostic impact and trends in utilization of invasive mechanical ventilation (IMV) and non-invasive ventilation (NIV) in patients hospitalized with ST-segment elevation myocardial infarction (STEMI) from 2002 through 2013 using the National Inpatient Sample. Multivariable logistic regression was performed to identify patient, hospital, and clinical characteristics associated with requiring IMV or NIV within 24-hours of hospitalization. Multivariable Cox proportional hazards regression was used to quantify the magnitude of in-hospital mortality associated with IMV and NIV use. Between 2002 and 2013, we identified 1,867,114 STEMI patients. Age, sex, higher comorbidity burden and chronic pulmonary disease were significantly associated with need for respiratory support. The use of IMV and NIV increased at average annual rates of 6.6% and 14.3%, respectively (Ptrend < 0.001). Age- and sex-adjusted mortality rates are high but declined for STEMI patients requiring IMV (44.7% in 2002 to 37.6% in 2013, Ptrend = 0.002) and NIV (11.6% in 2002 to 6.8% in 2013, Ptrend < 0.001). Compared to STEMI patients with no ventilation need, a requirement for IMV or NIV was associated with increased adjusted in-hospital mortality (hazard ratio [HR]: 2.5; p < 0.001 and [HR]: 1.7; p < 0.001, respectively). In conclusion, approximately 1 in 23 patients hospitalized with STEMI will require respiratory support in the form of IMV or NIV. STEMI patients who require respiratory support have a high risk of death, though rates of in-hospital mortality have decreased over time.

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Section: Discussionmentioning

confidence: 99%

Incidence and Prognostic Impact of Respiratory Support in Patients With ST-Segment Elevation Myocardial Infarction

Metkus

Albaeni

Chandra-Strobos

et al. 2017

The American Journal of Cardiology

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“…The included studies compared two different levels of PEEP using the same tidal volume in the two arms, thereby minimizing the risk of confounding effects of different tidal volume sizes. Indeed, as low tidal volume ventilation is associated with improved outcomes in patients without ARDS [37, 38], excluding RCTs comparing not only different levels of PEEP but also different tidal volume sizes increased the change that the associations, or absence of associations, were solely caused by the level of PEEP.…”

Section: Discussionmentioning

confidence: 99%

“…This could have augmented the risk of secondary injury in patients without ARDS [37, 38], and PEEP may have had other effects when higher tidal volumes are used, although this remains completely speculative. Substantial evidence indicates that mechanical ventilation per se contributed to the development of ARDS, i.e., through ventilation-induced lung injury (VILI) [1].…”

Section: Discussionmentioning

confidence: 99%

Associations between positive end-expiratory pressure and outcome of patients without ARDS at onset of ventilation: a systematic review and meta-analysis of randomized controlled trials

Neto

Filho

Cherpanath

et al. 2016

Ann. Intensive Care

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BackgroundThe aim of this investigation was to compare ventilation at different levels of positive end-expiratory pressure (PEEP) with regard to clinical important outcomes of intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) at onset of ventilation.MethodsMeta-analysis of randomized controlled trials (RCTs) comparing a lower level of PEEP with a higher level of PEEP was performed. The primary outcome was in-hospital mortality.ResultsTwenty-one RCTs (1393 patients) were eligible. PEEP ranged from 0 to 10 cmH2O and from 5 to 30 cmH2O in the lower PEEP and the higher PEEP arms of included RCTs, respectively. In-hospital mortality was not different between the two PEEP arms in seven RCTs (risk ratio [RR] 0.87; 95% confidence interval [CI] 0.62–1.21; I 2 = 26%, low quality of evidence [QoE]), as was duration of mechanical ventilation in three RCTs (standardized mean difference [SMD] 0.68; 95% CI −0.24 to 1.61; I 2 = 82%, very low QoE). PaO2/FiO2 was higher in the higher PEEP arms in five RCTs (SMD 0.72; 95% CI 0.10–1.35; I 2 = 86%, very low QoE). Development of ARDS and the occurrence of hypoxemia (2 RCTs) were lower in the higher PEEP arms in four RCTs and two RCTs, respectively (RR 0.43; 95% CI 0.21–0.91; I 2 = 56%, low QoE; RR 0.42; 95%–CI 0.19–0.92; I 2 = 19%, low QoE). There was no association between the level of PEEP and any hemodynamic parameter (four RCTs).ConclusionVentilation with higher levels of PEEP in ICU patients without ARDS at onset of ventilation was not associated with lower in-hospital mortality or shorter duration of ventilation, but with a lower incidence of ARDS and hypoxemia, as well as higher PaO2/FiO2. These findings should be interpreted with caution, as heterogeneity was moderate to high, the QoE was low to very low, and the available studies prevented us from addressing the effects of moderate levels of PEEP.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0208-7) contains supplementary material, which is available to authorized users.

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“…Observational studies suggest reductions in the development of ARDS with LPV use in patients at risk for ARDS but who had not yet developed the syndrome [101]. Two meta-analyses suggest that use of LPV in patients without ARDS reduces the duration of mechanical ventilation, the risk of pulmonary infection and the duration of hospitalization [102,103]. Given the frequency of respiratory failure in sepsis, with consequent high risk for developing ARDS and its attendant complications of prolonged mechanical ventilation and mortality, optimizing the approach to mechanical ventilation could save thousands of lives and reduce healthcare costs through reductions in mechanical ventilation and ICU stay.…”

Section: What Is the Role Of Lung Protective Ventilation In Septic Pamentioning

confidence: 99%

Surviving sepsis campaign: research priorities for sepsis and septic shock

et al. 2018

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Objective: To identify research priorities in the management, epidemiology, outcome and underlying causes of sepsis and septic shock.Design: A consensus committee of 16 international experts representing the European Society of Intensive Care Medicine and Society of Critical Care Medicine was convened at the annual meetings of both societies. Subgroups had teleconference and electronic-based discussion. The entire committee iteratively developed the entire document and recommendations.Methods: Each committee member independently gave their top five priorities for sepsis research. A total of 88 suggestions (ESM 1 -supplemental table 1) were grouped into categories by the committee co-chairs, leading to the formation of seven subgroups: infection, fluids and vasoactive agents, adjunctive therapy, administration/epidemiology, scoring/identification, post-intensive care unit, and basic/translational science. Each subgroup had teleconferences to go over each priority followed by formal voting within each subgroup. The entire committee also voted on top priorities across all subgroups except for basic/translational science. Results:The Surviving Sepsis Research Committee provides 26 priorities for sepsis and septic shock. Of these, the top six clinical priorities were identified and include the following questions: (1) can targeted/personalized/precision medicine approaches determine which therapies will work for which patients at which times?; (2) what are ideal endpoints for volume resuscitation and how should volume resuscitation be titrated?; (3) should rapid diagnostic tests be implemented in clinical practice?; (4) should empiric antibiotic combination therapy be used in sepsis or septic shock?; (5) what are the predictors of sepsis long-term morbidity and mortality?; and (6) what information identifies organ dysfunction?Conclusions: While the Surviving Sepsis Campaign guidelines give multiple recommendations on the treatment of sepsis, significant knowledge gaps remain, both in bedside issues directly applicable to clinicians, as well as understanding the fundamental mechanisms underlying the development and progression of sepsis. The priorities identified represent a roadmap for research in sepsis and septic shock.

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Association between tidal volume size, duration of ventilation, and sedation needs in patients without acute respiratory distress syndrome: an individual patient data meta-analysis

Cited by 114 publications

References 23 publications

Incidence and Prognostic Impact of Respiratory Support in Patients With ST-Segment Elevation Myocardial Infarction

Incidence and Prognostic Impact of Respiratory Support in Patients With ST-Segment Elevation Myocardial Infarction

Associations between positive end-expiratory pressure and outcome of patients without ARDS at onset of ventilation: a systematic review and meta-analysis of randomized controlled trials

Surviving sepsis campaign: research priorities for sepsis and septic shock

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