Clinical Predictors of Adherence to Low Tidal Volume Ventilation Practice: Is it Different on Weekend and Night Shifts?

Abstract

Background: Low tidal volume ventilation (LTVV) strategy improves outcomes; however, despite recommended by guidelines, adherence to this practice is not high. Methods: Tidal volume for mechanically ventilated patients were recorded for each 12hour shift, day and night shifts for consecutive 101 patients. Adherence was determined by comparing these tidal volumes to standard low tidal volumes of 6 ml/kg of ideal body weight. Adherence rates were calculated and adherence rates of daytime shifts were compared to those of night time shifts. Adherence rates for weekday shifts were compared with those of weekend shifts. Clinical variables were recorded to analyze predictors of adherence pattern. Results: The sample size was 101 patients with 870 patient-ventilator days with 1734 patient ventilator shifts. Shift adherence was only 47.5%. There was no significant difference between day and night shifts or weekday and weekend shifts. Stepwise multiple regression analysis shows that age, gender, body mass index (BMI), and partial pressure of carbon dioxide (PCO2) have significant correlation with adherence to LTVV practice. Conclusion: The study found that adherence to lung protective low tidal volume mechanical ventilation practice is low.

Effect of a Care Bundle Combined with Continuous Positive Airway Pressure in the Postanesthesia Care Unit on Rapid Recovery after Pulmonary Tumor Resection

“…One-lung ventilation is a commonly used ventilation mode in anesthesia for thoracic surgery, which allows ventilation of only the nonoperated lung by using an endobronchial tube, thereby improving the surgical field and facilitating surgical procedures [ 10 ]. According to the traditional views, the tidal volume of the lung on the ventilated side is 8–10 ml/kg; too small tidal volume may trigger atelectasis, while a relatively large tidal volume can increase ventilation and improve oxygenation [ 11 ]. However, large tidal volume and one-lung ventilation cause increased airway pressure, leading to oxidative stress, inflammatory factor release and tissue damage, and a higher rate of complications such as intraoperative hypoxemia and postoperative lung injury [ 12 – 14 ].…”

The Impact of Aging in Acute Respiratory Distress Syndrome: A Clinical and Mechanistic Overview

“…The use of conservative fluid management and low tidal volume ventilation (LTVV) has been shown to attenuate this age-associated increase in ventilator associated mortality in vivo (87). Clinically, the benefits of LTVV are uncertain and adherence among clinicians is low (88,89). Further study into the clinical benefits of LTVV specifically in the elderly subpopulation would be valuable.…”

Acute Respiratory Distress Syndrome in the Elderly

“…Lower tidal volume ventilation along with a conservative fluid strategy has been shown to be associated with positive outcomes; 10 however, this is poorly adhered to among clinicians. 11 Treatment options specific to the elderly need to be evolved, if we have to reduce the mortality in these patients. Considering, the underlying immune-aging and senescence of host cell, probable cell-based therapies—mesenchymal stem cell, T-regs, endothelial progenitor cell, etc.—offer an area of research and investigation.…”