Attaining Low Tidal Volume Ventilation During Patient Triggered Ventilation in Sedated Subjects.
BACKGROUND: Low tidal volume (VT) ventilation has become the preferred approach in patients in the ICU. Sedation reduces VT by attenuating respiratory drive. Even in deep sedation, some patients exhibit high VT. We aimed to determine factors associated with low VT ventilation in deeply sedated subje...
| Publicado en: | Respiratory Care Vol. 64; no. 8; pp. 890 - 899 |
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| Autores principales: | , , , , |
| Formato: | CEU equations & formulas research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Aug2019
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=137876006&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 137876006 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Aug2019 vid: 64 iid: 8 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 137876006 137876006 137876006 10.4187/respcare.06197 137876006 ppf: 890 ppct: 9 formats: fmt: @attributes: type: P tig: atl: Attaining Low Tidal Volume Ventilation During Patient Triggered Ventilation in Sedated Subjects. aug: au: Moe Koide Akinori Uchiyama Tomonori Yamashita Takeshi Yoshida Yuji Fujino affil: Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan sug: subj: Tidal Volume Sedation Respiration, Artificial Methods Inspiration, Respiratory Human Education, Continuing (Credit) Japan Intensive Care Units Retrospective Design Scales Positive End-Expiratory Pressure Multivariate Analysis Acid-Base Equilibrium Blood Gas Analysis Descriptive Statistics Mann-Whitney U Test Kruskal-Wallis Test Chi Square Test Post Hoc Analysis Univariate Statistics Multiple Logistic Regression Linear Regression Data Analysis Software Respiratory Mechanics Clinical Assessment Tools Male Female Middle Age Aged Narcotics Administration and Dosage Middle Aged: 45-64 years Aged: 65+ years Male Female ab: BACKGROUND: Low tidal volume (VT) ventilation has become the preferred approach in patients in the ICU. Sedation reduces VT by attenuating respiratory drive. Even in deep sedation, some patients exhibit high VT. We aimed to determine factors associated with low VT ventilation in deeply sedated subjects who exhibited an inspiratory effort by examination of the acid/base balance using the Stewart model. METHODS: The medical records of 630 consecutive subjects admitted to the ICU over 1 y were reviewed retrospectively, and daily data sets of patients with a persistent inspiratory effort, PaO2/FIO2 < 300 mm Hg, PEEP > 5 cm H2O, and a Richmond Agitation Sedation Scale score of -4 or -5 who received assisted pressure-regulated ventilation were collected. The data sets were stratified into high VT (≥ 8 mL/kg predicted body weight [PBW]) and low VT (> 8 mL/kg PBW) groups. RESULTS: Among 235 matched data sets from 100 subjects, 101 and 134 data sets were in the low VT and high VT groups, respectively. Set pressure was not different between the groups. PEEP was lower in the low VT group, and opioids were more frequently used in the high VT group. Strong ion difference (SID) was higher in the low VT group. Multivariate analysis revealed that higher SID, lower total nonvolatile weak anion (ATOT), and absence of opioid administration were associated with attaining low VT ventilation. Furthermore, VT/PBW and SID demonstrated a weak inverse correlation, whereas VT/PBW and ATOT exhibited a weak correlation. VT/PBW was lower in the group with higher SID and lower ATOT, indicating a tendency of metabolic alkalosis. CONCLUSIONS: Despite weak effects of high SID and low ATOT, efficient management of the buffering function might be a feasible strategy to achieve low VT ventilation. pubtype: Academic Journal doctype: CEU equations & formulas research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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