Airway pressures, tidal volumes, and mortality in patients with acute respiratory distress syndrome

Niall D. Ferguson, Fernando Frutos-Vivar, Andrés Esteban, Antonio R Anzueto, Inmaculada Alía, Roy G. Brower, Thomas E. Stewart, Carlos Apezteguía, Marco González, Luis Soto, Fekri Abroug, Laurent Brochard

Research output: Contribution to journalArticle

114 Citations (Scopus)

Abstract

Objective: To determine the usual practice for setting tidal volume and other ventilatory parameters in patients with acute respiratory distress syndrome (ARDS) in the late 1990s and to determine the independent effects of these practices on intensive care unit mortality. Design: Subanalysis of a prospective observational study. Multivariable logistic regression was used to analyze the effects of ventilatory management on mortality. Setting: A total of 361 intensive care units in 20 countries in March 1908. Patients: A total of 467 mechanically ventilated patients with ARDS. Interventions: None. Measurements and Main Results: The mean tidal volume used in the first week of ARDS was 8.8 mL/kg measured body weight, and there was great variability im these tidal volumes (SD = 2.0). Tidal volumes were significantly lower in patients with (n = 265) than without (n = 202) a recorded plateau pressure (8.6 vs. 9.1 mL/kg, p = .01). The overall intensive care unit mortality rate was 60.2%. In addition to the strong influence of organ failures and higher levels of inspired oxygen, late-onset ARDS (onset after >48 hrs of mechanical ventilation; odds ratio, 2.09) was independently associated with mortality. In addition, lower levels of positive end-expiratory pressure were independently associated with higher mortality (odds ratio, 0.91; 1 cm of H2O increments). Neither inspiratory pressures nor tidal volumes were independently associated with mortality, and there was no evidence of increased mortality with the use of lower inspiratory pressures. Conclusions: This descriptive study demonstrated considerable interpatient variability in tidal volumes during the study period. In addition to traditional prognostic indicators, timing of ARDS onset and the use of low levels of positive end-expiratory pressure or no positive end-expiratory pressure during the first week may adversely influence outcome in ARDS patients.

Original languageEnglish (US)
Pages (from-to)21-30
Number of pages10
JournalCritical Care Medicine
Volume33
Issue number1
DOIs
StatePublished - Jan 2005

Fingerprint

Tidal Volume
Adult Respiratory Distress Syndrome
Pressure
Mortality
Positive-Pressure Respiration
Intensive Care Units
Odds Ratio
Artificial Respiration
Observational Studies
Logistic Models
Body Weight
Prospective Studies
Oxygen

Keywords

  • Adult
  • Artificial
  • Mechanical
  • Positive-pressure respiration
  • Respiration
  • Respiratory distress syndrome
  • Tidal volume
  • Ventilators

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Airway pressures, tidal volumes, and mortality in patients with acute respiratory distress syndrome. / Ferguson, Niall D.; Frutos-Vivar, Fernando; Esteban, Andrés; Anzueto, Antonio R; Alía, Inmaculada; Brower, Roy G.; Stewart, Thomas E.; Apezteguía, Carlos; González, Marco; Soto, Luis; Abroug, Fekri; Brochard, Laurent.

In: Critical Care Medicine, Vol. 33, No. 1, 01.2005, p. 21-30.

Research output: Contribution to journalArticle

Ferguson, ND, Frutos-Vivar, F, Esteban, A, Anzueto, AR, Alía, I, Brower, RG, Stewart, TE, Apezteguía, C, González, M, Soto, L, Abroug, F & Brochard, L 2005, 'Airway pressures, tidal volumes, and mortality in patients with acute respiratory distress syndrome', Critical Care Medicine, vol. 33, no. 1, pp. 21-30. https://doi.org/10.1097/01.CCM.0000150652.91411.66
Ferguson, Niall D. ; Frutos-Vivar, Fernando ; Esteban, Andrés ; Anzueto, Antonio R ; Alía, Inmaculada ; Brower, Roy G. ; Stewart, Thomas E. ; Apezteguía, Carlos ; González, Marco ; Soto, Luis ; Abroug, Fekri ; Brochard, Laurent. / Airway pressures, tidal volumes, and mortality in patients with acute respiratory distress syndrome. In: Critical Care Medicine. 2005 ; Vol. 33, No. 1. pp. 21-30.
@article{988b35d80f6441d4b17a49546e512f66,
title = "Airway pressures, tidal volumes, and mortality in patients with acute respiratory distress syndrome",
abstract = "Objective: To determine the usual practice for setting tidal volume and other ventilatory parameters in patients with acute respiratory distress syndrome (ARDS) in the late 1990s and to determine the independent effects of these practices on intensive care unit mortality. Design: Subanalysis of a prospective observational study. Multivariable logistic regression was used to analyze the effects of ventilatory management on mortality. Setting: A total of 361 intensive care units in 20 countries in March 1908. Patients: A total of 467 mechanically ventilated patients with ARDS. Interventions: None. Measurements and Main Results: The mean tidal volume used in the first week of ARDS was 8.8 mL/kg measured body weight, and there was great variability im these tidal volumes (SD = 2.0). Tidal volumes were significantly lower in patients with (n = 265) than without (n = 202) a recorded plateau pressure (8.6 vs. 9.1 mL/kg, p = .01). The overall intensive care unit mortality rate was 60.2{\%}. In addition to the strong influence of organ failures and higher levels of inspired oxygen, late-onset ARDS (onset after >48 hrs of mechanical ventilation; odds ratio, 2.09) was independently associated with mortality. In addition, lower levels of positive end-expiratory pressure were independently associated with higher mortality (odds ratio, 0.91; 1 cm of H2O increments). Neither inspiratory pressures nor tidal volumes were independently associated with mortality, and there was no evidence of increased mortality with the use of lower inspiratory pressures. Conclusions: This descriptive study demonstrated considerable interpatient variability in tidal volumes during the study period. In addition to traditional prognostic indicators, timing of ARDS onset and the use of low levels of positive end-expiratory pressure or no positive end-expiratory pressure during the first week may adversely influence outcome in ARDS patients.",
keywords = "Adult, Artificial, Mechanical, Positive-pressure respiration, Respiration, Respiratory distress syndrome, Tidal volume, Ventilators",
author = "Ferguson, {Niall D.} and Fernando Frutos-Vivar and Andr{\'e}s Esteban and Anzueto, {Antonio R} and Inmaculada Al{\'i}a and Brower, {Roy G.} and Stewart, {Thomas E.} and Carlos Apeztegu{\'i}a and Marco Gonz{\'a}lez and Luis Soto and Fekri Abroug and Laurent Brochard",
year = "2005",
month = "1",
doi = "10.1097/01.CCM.0000150652.91411.66",
language = "English (US)",
volume = "33",
pages = "21--30",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Airway pressures, tidal volumes, and mortality in patients with acute respiratory distress syndrome

AU - Ferguson, Niall D.

AU - Frutos-Vivar, Fernando

AU - Esteban, Andrés

AU - Anzueto, Antonio R

AU - Alía, Inmaculada

AU - Brower, Roy G.

AU - Stewart, Thomas E.

AU - Apezteguía, Carlos

AU - González, Marco

AU - Soto, Luis

AU - Abroug, Fekri

AU - Brochard, Laurent

PY - 2005/1

Y1 - 2005/1

N2 - Objective: To determine the usual practice for setting tidal volume and other ventilatory parameters in patients with acute respiratory distress syndrome (ARDS) in the late 1990s and to determine the independent effects of these practices on intensive care unit mortality. Design: Subanalysis of a prospective observational study. Multivariable logistic regression was used to analyze the effects of ventilatory management on mortality. Setting: A total of 361 intensive care units in 20 countries in March 1908. Patients: A total of 467 mechanically ventilated patients with ARDS. Interventions: None. Measurements and Main Results: The mean tidal volume used in the first week of ARDS was 8.8 mL/kg measured body weight, and there was great variability im these tidal volumes (SD = 2.0). Tidal volumes were significantly lower in patients with (n = 265) than without (n = 202) a recorded plateau pressure (8.6 vs. 9.1 mL/kg, p = .01). The overall intensive care unit mortality rate was 60.2%. In addition to the strong influence of organ failures and higher levels of inspired oxygen, late-onset ARDS (onset after >48 hrs of mechanical ventilation; odds ratio, 2.09) was independently associated with mortality. In addition, lower levels of positive end-expiratory pressure were independently associated with higher mortality (odds ratio, 0.91; 1 cm of H2O increments). Neither inspiratory pressures nor tidal volumes were independently associated with mortality, and there was no evidence of increased mortality with the use of lower inspiratory pressures. Conclusions: This descriptive study demonstrated considerable interpatient variability in tidal volumes during the study period. In addition to traditional prognostic indicators, timing of ARDS onset and the use of low levels of positive end-expiratory pressure or no positive end-expiratory pressure during the first week may adversely influence outcome in ARDS patients.

AB - Objective: To determine the usual practice for setting tidal volume and other ventilatory parameters in patients with acute respiratory distress syndrome (ARDS) in the late 1990s and to determine the independent effects of these practices on intensive care unit mortality. Design: Subanalysis of a prospective observational study. Multivariable logistic regression was used to analyze the effects of ventilatory management on mortality. Setting: A total of 361 intensive care units in 20 countries in March 1908. Patients: A total of 467 mechanically ventilated patients with ARDS. Interventions: None. Measurements and Main Results: The mean tidal volume used in the first week of ARDS was 8.8 mL/kg measured body weight, and there was great variability im these tidal volumes (SD = 2.0). Tidal volumes were significantly lower in patients with (n = 265) than without (n = 202) a recorded plateau pressure (8.6 vs. 9.1 mL/kg, p = .01). The overall intensive care unit mortality rate was 60.2%. In addition to the strong influence of organ failures and higher levels of inspired oxygen, late-onset ARDS (onset after >48 hrs of mechanical ventilation; odds ratio, 2.09) was independently associated with mortality. In addition, lower levels of positive end-expiratory pressure were independently associated with higher mortality (odds ratio, 0.91; 1 cm of H2O increments). Neither inspiratory pressures nor tidal volumes were independently associated with mortality, and there was no evidence of increased mortality with the use of lower inspiratory pressures. Conclusions: This descriptive study demonstrated considerable interpatient variability in tidal volumes during the study period. In addition to traditional prognostic indicators, timing of ARDS onset and the use of low levels of positive end-expiratory pressure or no positive end-expiratory pressure during the first week may adversely influence outcome in ARDS patients.

KW - Adult

KW - Artificial

KW - Mechanical

KW - Positive-pressure respiration

KW - Respiration

KW - Respiratory distress syndrome

KW - Tidal volume

KW - Ventilators

UR - http://www.scopus.com/inward/record.url?scp=19944429978&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=19944429978&partnerID=8YFLogxK

U2 - 10.1097/01.CCM.0000150652.91411.66

DO - 10.1097/01.CCM.0000150652.91411.66

M3 - Article

C2 - 15644644

AN - SCOPUS:19944429978

VL - 33

SP - 21

EP - 30

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 1

ER -