Skip to main content
Erschienen in: Intensive Care Medicine 7/2005

01.07.2005 | Original

Ventilator settings as a risk factor for acute respiratory distress syndrome in mechanically ventilated patients

verfasst von: Ognjen Gajic, Fernando Frutos-Vivar, André Esteban, Rolf D. Hubmayr, Antonio Anzueto

Erschienen in: Intensive Care Medicine | Ausgabe 7/2005

Einloggen, um Zugang zu erhalten

Abstract

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 cmH2O), 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.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Goss CH, Brower RG, Hudson LD, Rubenfeld GD (2003) Incidence of acute lung injury in the United States. Crit Care Med 31:1607–1611 Goss CH, Brower RG, Hudson LD, Rubenfeld GD (2003) Incidence of acute lung injury in the United States. Crit Care Med 31:1607–1611
2.
Zurück zum Zitat Ware LB, Matthay MA (2000) The acute respiratory distress syndrome. N Engl J Med 342:1334–1349 Ware LB, Matthay MA (2000) The acute respiratory distress syndrome. N Engl J Med 342:1334–1349
3.
Zurück zum Zitat Hudson LD, Milberg JA, Anardi D, Maunder RJ (1995) Clinical risks for development of the acute respiratory distress syndrome. Am J Respir Crit Care Med 151:293–301 Hudson LD, Milberg JA, Anardi D, Maunder RJ (1995) Clinical risks for development of the acute respiratory distress syndrome. Am J Respir Crit Care Med 151:293–301
4.
Zurück zum Zitat Pepe PE, Potkin RT, Reus DH, Hudson LD, Carrico CJ (1982) Clinical predictors of the adult respiratory distress syndrome. Am J Surg 144:124–130 Pepe PE, Potkin RT, Reus DH, Hudson LD, Carrico CJ (1982) Clinical predictors of the adult respiratory distress syndrome. Am J Surg 144:124–130
5.
Zurück zum Zitat 1999 International consensus conferences in intensive care medicine (1999) Ventilator-associated lung injury in ARDS. This official conference report was cosponsored by the American Thoracic Society, The European Society of Intensive Care Medicine, and The Societe de Reanimation de Langue Francaise, and was approved by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med 160:2118–2124 1999 International consensus conferences in intensive care medicine (1999) Ventilator-associated lung injury in ARDS. This official conference report was cosponsored by the American Thoracic Society, The European Society of Intensive Care Medicine, and The Societe de Reanimation de Langue Francaise, and was approved by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med 160:2118–2124
6.
Zurück zum Zitat Dreyfuss D, Basset G, Soler P, Saumon G (1985) Intermittent positive-pressure hyperventilation with high inflation pressures produces pulmonary microvascular injury in rats. Am Rev Respir Dis 132:880–884 Dreyfuss D, Basset G, Soler P, Saumon G (1985) Intermittent positive-pressure hyperventilation with high inflation pressures produces pulmonary microvascular injury in rats. Am Rev Respir Dis 132:880–884
7.
Zurück zum Zitat Gajic O, Lee J, Doerr CH, Berrios JC, Myers JL, Hubmayr RD (2003) Ventilator-induced cell wounding and repair in the intact lung. Am J Respir Crit Care Med 167:1057–1063 Gajic O, Lee J, Doerr CH, Berrios JC, Myers JL, Hubmayr RD (2003) Ventilator-induced cell wounding and repair in the intact lung. Am J Respir Crit Care Med 167:1057–1063
8.
Zurück zum Zitat The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308 The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308
9.
Zurück zum Zitat Gajic O, Dara S, Mendez J, Adesanya A, Festic E, Caples S, Rana R, St Sauver J, Lymp J, Afessa B, Hubmayr RD (2004) Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation. Crit Care Med 32:1817–1824 Gajic O, Dara S, Mendez J, Adesanya A, Festic E, Caples S, Rana R, St Sauver J, Lymp J, Afessa B, Hubmayr RD (2004) Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation. Crit Care Med 32:1817–1824
10.
Zurück zum Zitat Esteban A, Anzueto A, Frutos F, Alia I, Brochard L, Stewart TE, Benito S, Epstein SK, Apezteguia C, Nightingale P, Arroliga AC, Tobin MJ (2002) Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 287:345–355 Esteban A, Anzueto A, Frutos F, Alia I, Brochard L, Stewart TE, Benito S, Epstein SK, Apezteguia C, Nightingale P, Arroliga AC, Tobin MJ (2002) Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 287:345–355
11.
Zurück zum Zitat Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R (1994) The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149:818–824 Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R (1994) The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149:818–824
12.
Zurück zum Zitat Rubenfeld GD, Caldwell E, Granton J, Hudson LD, Matthay MA (1999) Interobserver variability in applying a radiographic definition for ARDS. Chest 116:1347–1353 Rubenfeld GD, Caldwell E, Granton J, Hudson LD, Matthay MA (1999) Interobserver variability in applying a radiographic definition for ARDS. Chest 116:1347–1353
13.
Zurück zum Zitat The National Heart, Lung, and Blood Institute ARDS Clinical Trials Network (2004) Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med 351:327–336 The National Heart, Lung, and Blood Institute ARDS Clinical Trials Network (2004) Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med 351:327–336
14.
Zurück zum Zitat Gajic O, Mendez JC, Rickman OB, Lymp JF, Hubmayr RD, Moore SB (2004) Acute lung injury after blood transfusion in mechanically ventilated patients. Transfusion 44:1468–1474 Gajic O, Mendez JC, Rickman OB, Lymp JF, Hubmayr RD, Moore SB (2004) Acute lung injury after blood transfusion in mechanically ventilated patients. Transfusion 44:1468–1474
15.
Zurück zum Zitat McClintock DE, Matthay MA (2004) Why does acute lung injury have no impact on mortality in patients with major trauma? Crit Care Med 32:583–584 McClintock DE, Matthay MA (2004) Why does acute lung injury have no impact on mortality in patients with major trauma? Crit Care Med 32:583–584
Metadaten
Titel
Ventilator settings as a risk factor for acute respiratory distress syndrome in mechanically ventilated patients
verfasst von
Ognjen Gajic
Fernando Frutos-Vivar
André Esteban
Rolf D. Hubmayr
Antonio Anzueto
Publikationsdatum
01.07.2005
Verlag
Springer-Verlag
Erschienen in
Intensive Care Medicine / Ausgabe 7/2005
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-005-2625-1

Weitere Artikel der Ausgabe 7/2005

Intensive Care Medicine 7/2005 Zur Ausgabe

Announcements

July 2005

Physiological Note

Venous oximetry

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.