Intraoperative adherence to a low tidal volume ventilation strategy in critically ill patients with preexisting acute lung injury

Chaiwat, Onuma; Vavilala, Monica S.; Philip, Shaji; Malakouti, Amin; Neff, Margaret J.; Deem, Steven; Wang, Jin; Lang, Janet M.

doi:10.1016/j.jcrc.2010.08.002

Cited by 15 publications

(20 citation statements)

References 24 publications

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“…Ventilators that permit real-time monitoring of airway pressures and other variables may have allowed us to collect more data throughout the operative period [37,41]. We did not evaluate the evolution of ventilatory practices over time, specifically with respect to the impact of the adoption of protective lung ventilation concepts developed in ICU patients [42]. Also, we did not compare the ventilatory practices between physicians who work both in the operating room and the ICU with those who have no activity in the ICU.…”

Section: Discussionmentioning

confidence: 99%

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

Coisel²,

et al. 2012

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SummaryWe conducted an observational prospective multicenter study to describe the practices of mechanical ventilation, to determine the incidence of use of large intra-operative tidal volumes ( ‡ 10 ml.kg )1 of ideal body weight) and to identify patient factors associated with this practice. Of the 2960 patients studied in 97 anaesthesia units from 49 hospitals, volume controlled mode was the most commonly used (85%). The mean (SD) tidal volume was 533 (82) ml; 7.7 (1.3) ml.kg )1 (actual weight) and 8.8 (1.4) ml.kg )1 (ideal body weight)). The lungs of 381 (18%) patients were ventilated with a tidal volume > 10 ml.kg )1 ideal body weight. Being female ) and by logistic regression, underweight (OR 0.06 (95% CI 0.01-0.45)), overweight (OR 1.98 (95% CI 1.49-2.65)), obese )), severely obese ) and morbidly obese .03)) were the significant (p £ 0.005) independent factors for the use of large tidal volumes during anaesthesia.

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Section: Discussionmentioning

confidence: 99%

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

Coisel²,

et al. 2012

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“…Although the clinical guidelines recommend lung protective ventilation with low tidal volumes, current clinical practice often deviates from these recommendations. 26,27 Therefore this model of ALI is still clinically relevant. Our in vivo and in vitro data show that neutrophils only release NETs when they are simultaneously activated by integrin-mediated outside-in-and G-protein-coupled receptor (GPCR) signaling.…”

Section: Introductionmentioning

confidence: 99%

Synchronized integrin engagement and chemokine activation is crucial in neutrophil extracellular trap–mediated sterile inflammation

Rossaint

Herter

Aken

et al. 2014

Blood

237

261

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Key Points• NET formation is required for neutrophil recruitment during sterile inflammation.• Platelet-induced NET formation requires stimulation of neutrophils by platelet chemokines and outside-in signaling via the integrin Mac-1.There is emerging evidence that neutrophil extracellular traps (NETs) play important roles in inflammatory processes. Here we report that neutrophils have to be simultaneously activated by integrin-mediated outside-in-and G-protein-coupled receptor (GPCR) signaling to induce NET formation in acute lung injury (ALI), which is associated with a high mortality rate in critically ill patients. NETs consist of decondensed chromatin decorated with granular and cytosolic proteins and they can trap extracellular pathogens. The prerequisite for NET formation is the activation of neutrophils and the release of their DNA. In a neutrophil-and platelet-dependent mouse model of ventilator-induced lung injury (VILI), NETs were found in the lung microvasculature, and circulating NET components increased in the plasma. In this model, blocking integrin-mediated outside-in or either GPCR-signaling or heteromerization of platelet chemokines decreased NET formation and lung injury. Targeting NET components by DNAse1 application or neutrophil elastase-deficient mice protected mice from ALI, whereas DNase1 2/2 /Trap1 m/m mice had an aggravated ALI, suggesting that NETs directly influence the severity of ALI. These data suggest that NETs form in the lungs during VILI, contribute to the disease process, and thus may be a promising new direction for the treatment of ALI. (Blood. 2014; 123(16):2573-2584

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“…Avoidance of these complications is the prudent approach with both appropriate intraoperative ventilation and a postoperative multi-faceted protocol. [53][54][55][56][57] ACT has been used for the prevention and treatment of postoperative pulmonary complications for many years. However, there are many causes of atelectasis, 58 and the use of ACT in the setting of atelectasis without retained airway secretions does not appear to be effective.…”

Section: Discussionmentioning

confidence: 99%

“…Time honored therapies without sufficient evidence should be abandoned in favor of multi-faceted approaches that include patient education, collaborative care, and early ambulation. [53][54][55][56][57] Routine use of incentive spirometry cannot be supported as a therapy to prevent postoperative complications. CPAP by face mask can alleviate hypoxemia due to low tidal volumes and airway obstruction, and may avoid reintubation, but there is no high-level evidence that this improves airway clearance.…”

Section: Discussionmentioning

confidence: 99%

AARC Clinical Practice Guideline: Effectiveness of Nonpharmacologic Airway Clearance Therapies in Hospitalized Patients

et al. 2013

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Airway clearance therapy (ACT) is used in a variety of settings for a variety of ailments. These guidelines were developed from a systematic review with the purpose of determining whether the use of nonpharmacologic ACT improves oxygenation, reduces length of time on the ventilator, reduces stay in the ICU, resolves atelectasis/consolidation, and/or improves respiratory mechanics, versus usual care in 3 populations. For hospitalized, adult and pediatric patients without cystic fibrosis, 1) chest physiotherapy (CPT) is not recommended for the routine treatment of uncomplicated pneumonia; 2) ACT is not recommended for routine use in patients with COPD; 3) ACT may be considered in patients with COPD with symptomatic secretion retention, guided by patient preference, toleration, and effectiveness of therapy; 4) ACT is not recommended if the patient is able to mobilize secretions with cough, but instruction in effective cough technique may be useful. For adult and pediatric patients with neuromuscular disease, respiratory muscle weakness, or impaired cough, 1) cough assist techniques should be used in patients with neuromuscular disease, particularly when peak cough flow is < 270 L/min; CPT, positive expiratory pressure, intrapulmonary percussive ventilation, and high-frequency chest wall compression cannot be recommended, due to insufficient evidence. For postoperative adult and pediatric patients, 1) incentive spirometry is not recommended for routine, prophylactic use in postoperative patients, 2) early mobility and ambulation is recommended to reduce postoperative complications and promote airway clearance, 3) ACT is not recommended for routine postoperative care. The lack of available high-level evidence related to ACT should prompt the design and completion of properly designed studies to determine the appropriate role for these therapies.

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Intraoperative adherence to a low tidal volume ventilation strategy in critically ill patients with preexisting acute lung injury

Cited by 15 publications

References 24 publications

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

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

Synchronized integrin engagement and chemokine activation is crucial in neutrophil extracellular trap–mediated sterile inflammation

AARC Clinical Practice Guideline: Effectiveness of Nonpharmacologic Airway Clearance Therapies in Hospitalized Patients

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