Standardizing Predicted Body Weight Equations for Mechanical Ventilation Tidal Volume Settings

Linares-Perdomo, Olinto; East, Thomas D.; Brower, Roy G.; Morris, Alan H.

doi:10.1378/chest.14-2843

Cited by 60 publications

(29 citation statements)

References 12 publications

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“…First of all, a low tidal volume of around 6 mL/kg of predicted body weight (PBW) is recommended to avoid barotrauma and volutrauma [2,3]. The PBW may be calculated as follows: X + 0,91 ˟ (height in centimeters -152,4) (X = 50 and 45,5 for men and women, respectively) [4]. Also, a lung-protective strategy with a limited plateau pressure has been validated to reduce barotrauma.…”

Section: Descriptionmentioning

confidence: 99%

COVID-19 pandemic: overview of protective-ventilation strategy in ARDS patients

Higny

Feye

Forêt

2020

Acta Clinica Belgica

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Objectives: In the context of COVID-19 pandemic, the aim of this manuscript is to provide a standard of care of patients with ARDS for non-emergency medicine trained physicians who are not customary with mechanical ventilation. Methods: We conducted a systematic review of the literature to investigate the best practice recommendations regarding the mechanical ventilation of patients with ARDS. Conclusion: We summarized the principal strategies for lung-protective ventilation of patients with ARDS. This focus is particularly addressed to physicians who are not experienced in the invasive respiratory management of ARDS patients. Nevertheless, it remains fundamental to acknowledge that new insights concerning this quickly spreading illness become available on a regular base.

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Section: Descriptionmentioning

confidence: 99%

COVID-19 pandemic: overview of protective-ventilation strategy in ARDS patients

Higny

Feye

Forêt

2020

Acta Clinica Belgica

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“…The patient's lungs were mechanically ventilated with a mixture of oxygen in air, with an inspired oxygen fraction of 0.5 using the volume-controlled mode. V T was adjusted to 6 ml/kg predicted body weight (PBW, determined as x + 0.91[height (in cm) − 152.4], where x = 50 for males and x = 45.5 for females) [22]. The PEEP of 5 cm H 2 O was applied without inspiratory pause.…”

Section: Anesthetic Techniquementioning

confidence: 99%

Temporary increase in tidal volume to improve the reliability of dynamic preload indices during robot-assisted laparoscopic surgery in the Trendelenburg position with lung-protective ventilation

Jiang

Chung

Baik

et al. 2019

Preprint

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Background: Pulse pressure variation (PPV) and stroke volume variation (SVV) induced by mechanical ventilation are widely used as predictors of fluid responsiveness. However, the reliability of these dynamic preload indices is controversial under pneumoperitoneum. In addition, the usefulness of these indices is being called into question with the increasing adoption of lung-protective ventilation using low tidal volume (VT) in surgical patients. We investigated whether increasing tidal volume (VT) from 6 to 8 ml/kg can improve the predictive power of PPV and SVV during pneurmoperitoneum.Methods: We performed a prospective observational study in patients undergoing robot-assisted laparoscopic surgery in the Trendelenburg position under lung-protective ventilation. PPV, SVV, and the stroke volume index (SVI) were measured at a VT of 6 mL/kg and 3 minutes after increasing the VT to 8 mL/kg. The VT was reduced to 6 mL/kg, and measurements were performed before and 5 minutes after volume expansion (infusing 6% hydroxyethyl starch 6 ml/kg over 10 minutes). Fluid responsiveness was defined as ≥ 15% increase in the SVI. Results: Twenty-four of the 38 patients enrolled in the study were responders. In the receiver operating characteristic curve analysis, the augmented PPV and SVV associated with a temporary increase in VT from 6 to 8 ml/kg improved the predictability of fluid responsiveness, with area under the curve (AUC) values of 0.85 (95% confidence interval (CI), 0.70-0.95, P < 0.0001) and 0.77 (95% CI 0.61-0.89, P = 0.0003), compared to PPV and SVV values (as measured by VT) of 6 ml/kg. The absolute change in PPV and SVV values obtained by transiently increasing VT also predicted fluid responsiveness, with AUC values of 0.95 (95% CI 0.83-0.99, P < 0.0001) and 0.76 (95% CI 0.60-0.89, P = 0.0006). Conclusions: Augmented PPV and SVV values, and absolute changes therein obtained by increasing VT from 6 to 8 ml/kg, predicted fluid responsiveness with high sensitivity and specificity in our surgical population. BackgroundRobot-assisted laparoscopic surgery is increasingly performed due to its many advantages over open surgery, including minimal tissue trauma, fewer surgical complications, and earlier postoperative recovery [1]. However, while pneumoperitoneum is essential for adequate exposure in robot-assisted laparoscopic surgery, it has been associated with increased morbidity such as reduced renal blood

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“…For adults, PBW formulae do exist, with 2 different approaches used to predict lean body mass in the early ARDS studies [1, 13]. The difference in estimated PBW between these 2 approaches can vary by up to 30% [14, 15]. Consequently standardization has been proposed [15].…”

Section: Introductionmentioning

confidence: 99%

Predicted body weight relationships for protective ventilation – unisex proposals from pre-term through to adult

Martin

Richards

2017

BMC Pulm Med

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BackgroundThe lung-protective ventilation bundle has been shown to reduce mortality in adult acute respiratory distress syndrome (ARDS). This concept has expanded to other areas of acute adult ventilation and is recommended for pediatric ventilation. A component of lung-protective ventilation relies on a prediction of lean body weight from height. The predicted body weight (PBW) relationship employed in the ARDS Network trial is considered valid only for adults, with a dedicated formula required for each sex. No agreed PBW formula applies to smaller body sizes. This analysis investigated whether it might be practical to derive a unisex PBW formula spanning all body sizes, while retaining relevance to established adult protective ventilation practice.MethodsHistoric population-based growth charts were adopted as a reference for lean body weight, from pre-term infant through to adult median weight. The traditional ARDSNet PBW formulae acted as the reference for prevailing protective ventilation practice. Error limits for derived PBW models were relative to these references.ResultsThe ARDSNet PBW formulae typically predict weights heavier than the population median, therefore no single relationship could satisfy both references. Four alternate piecewise-linear lean body-weight predictive formulae were presented for consideration, each with different balance between the objectives.ConclusionsThe ‘PBWuf + MBW’ model is proposed as an appropriate compromise between prevailing practice and simplification, while also better representing lean adult body-weight. This model applies the ARDSNet ‘female’ formula to both adult sexes, while providing a tight fit to median body weight at smaller statures down to pre-term. The ‘PBWmf + MBW’ model retains consistency with current practice over the adult range, while adding prediction for small statures.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-017-0427-1) contains supplementary material, which is available to authorized users.

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Standardizing Predicted Body Weight Equations for Mechanical Ventilation Tidal Volume Settings

Cited by 60 publications

References 12 publications

COVID-19 pandemic: overview of protective-ventilation strategy in ARDS patients

COVID-19 pandemic: overview of protective-ventilation strategy in ARDS patients

Temporary increase in tidal volume to improve the reliability of dynamic preload indices during robot-assisted laparoscopic surgery in the Trendelenburg position with lung-protective ventilation

Predicted body weight relationships for protective ventilation – unisex proposals from pre-term through to adult

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