TY - JOUR
T1 - Ventilator settings as a risk factor for acute respiratory distress syndrome in mechanically ventilated patients
AU - Gajic, Ognjen
AU - Frutos-Vivar, Fernando
AU - Esteban, André
AU - Hubmayr, Rolf D.
AU - Anzueto, Antonio
N1 - Funding Information:
Electronic Supplementary Material Supplementary material is available in the online version of this article at http:// dx.doi.org/10.1007/s00134-005-2625-1 This study was funded by grant 98/0233 from the Fondo de Investigación Sanitaria, Spain and the Red GIRA (G03/063) and Red RESPIRA (C03/11) from the Instituto de Salud Carlos III, Spain, and in part by funds from the Mayo Foundation.
PY - 2005/6
Y1 - 2005/6
N2 - Objective: A single-center retrospective study initial recently identified ventilator settings as a major risk factor for the development of acute respiratory distress syndrome (ARDS) in mechanically ventilated patients who do not have ARDS from the outset. We tested this hypothesis in a larger sample of patients prospectively enrolled in a multicenter study on mechanical ventilation. Design and setting: From a large international mechanical ventilation study database we identified patients who required mechanical ventilation for 48 h or more but did not have ARDS at the onset of mechanical ventilation. We extracted information on demographics, initial severity of illness, ventilator settings and major underlying ARDS risk factors. Primary outcome was development of ARDS after the onset of mechanical ventilation. Measurements and results: Of 3,261 mechanically ventilated patients who did not have ARDS at the outset 205 (6.2%) developed ARDS 48 h or more after the onset of mechanical ventilation. Multivariate logistic regression analysis adjusted for baseline patient characteristics (age, gender, Simplified Acute Physiology Score, hypoxemia) and underlying ARDS risk factors (sepsis, trauma, pneumonia) found the development of ARDS to be associated with the initial ventilator settings: high tidal volume (odds ratio 2.6 for tidal volume >700 ml), high peak airway pressure (odds ratio 1.6 for peak airway pressure >30 cmH 2O), and high positive end-expiratory pressure (odds ratio 1.7 for end-expiratory pressure >5 cmH2O). Conclusions: The association with the potentially injurious initial ventilator settings, in particular large tidal volumes, suggests that ARDS in mechanically ventilated patients is in part a preventable complication. This hypothesis needs to be tested in a prospective study.
AB - Objective: A single-center retrospective study initial recently identified ventilator settings as a major risk factor for the development of acute respiratory distress syndrome (ARDS) in mechanically ventilated patients who do not have ARDS from the outset. We tested this hypothesis in a larger sample of patients prospectively enrolled in a multicenter study on mechanical ventilation. Design and setting: From a large international mechanical ventilation study database we identified patients who required mechanical ventilation for 48 h or more but did not have ARDS at the onset of mechanical ventilation. We extracted information on demographics, initial severity of illness, ventilator settings and major underlying ARDS risk factors. Primary outcome was development of ARDS after the onset of mechanical ventilation. Measurements and results: Of 3,261 mechanically ventilated patients who did not have ARDS at the outset 205 (6.2%) developed ARDS 48 h or more after the onset of mechanical ventilation. Multivariate logistic regression analysis adjusted for baseline patient characteristics (age, gender, Simplified Acute Physiology Score, hypoxemia) and underlying ARDS risk factors (sepsis, trauma, pneumonia) found the development of ARDS to be associated with the initial ventilator settings: high tidal volume (odds ratio 2.6 for tidal volume >700 ml), high peak airway pressure (odds ratio 1.6 for peak airway pressure >30 cmH 2O), and high positive end-expiratory pressure (odds ratio 1.7 for end-expiratory pressure >5 cmH2O). Conclusions: The association with the potentially injurious initial ventilator settings, in particular large tidal volumes, suggests that ARDS in mechanically ventilated patients is in part a preventable complication. This hypothesis needs to be tested in a prospective study.
KW - Pulmonary edema, pneumonia
KW - Respiration Artificial, adverse effects
KW - Respiratory distress syndrome, adult
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U2 - 10.1007/s00134-005-2625-1
DO - 10.1007/s00134-005-2625-1
M3 - Article
C2 - 15856172
AN - SCOPUS:21744462913
SN - 0342-4642
VL - 31
SP - 922
EP - 926
JO - Intensive care medicine
JF - Intensive care medicine
IS - 7
ER -