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- W2769832823 abstract "Introduction The benefits of lung protective ventilation have been replicated in multiple trials. 1,2 However, we suspected that adherence to this standard of care remained poor. Using the NIHR critical care Health Informatics Collaborative (ccHIC) database, we analysed data from 11 teaching hospital intensive care units (22 524 patient episodes) to investigate real-world clinical practice. Methods 1248 patient episodes, where ventilation was continued for ≥48 hours, with 232,600 hours of concurrent mechanical ventilation and blood gas data were identified as suitable for analysis. Short gaps in ventilation ( Results The median tidal volume received by patients was 7.3 ml/kg -1 PBW (IQR:5.7–8.8). Female patients, especially those with higher BMI (≥30 kgm -2 ) consistently received higher tidal volumes than males. Patients with severe respiratory failure (PaO 2 :FiO 2 -1 PBW, and had 71% ICU mortality (Table 1). Patients with respiratory failure sufficient to qualify for recruitment into recent clinical trials (PaO 2 :FiO 2 2 0), who were exposed to tidal volumes≥12 ml/kg -1 PBW for longer than two hours had significantly increased risk of ICU mortality (odds ratio=2.89 [1.25–7.2]; p=0.007); This was not observed for patients with PaO 2 :FiO 2 ≥40 kPa (odds ratio=0.95 [0.58–1.56], p=0.91). Conclusions More than 15 years after the ARMA study 1 demonstrated a mortality benefit from lung protective ventilation, we are still not implementing 6 ml/kg -1 PBW ventilation into clinical practice, and are exposing even patients with a severe respiratory failure (PaO 2 :FiO 2 2 :FiO 2 2 :FiO 2 ≥40 kPa. References ARDS Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for ALI and ARDS. NEJM 2000;342:1301–1308. Futier E et al . A trial of intraoperative low tidal volume ventilation in abdominal surgery. NEJM 2013;369:428–437." @default.
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- W2769832823 date "2017-11-15" @default.
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- W2769832823 title "S136 Lung protective mechanical ventilation for acute respiratory failure is not being implemented in uk clinical practice" @default.
- W2769832823 doi "https://doi.org/10.1136/thoraxjnl-2017-210983.142" @default.
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