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  • Poster presentation
  • Open Access

Dutch intensivists do not use small tidal volumes (Vt) in mechanical ventilation (MV)

  • 1,
  • 2,
  • 3,
  • 1 and
  • 1
Critical Care20048 (Suppl 1) :P26

https://doi.org/10.1186/cc2493

  • Published:

Keywords

  • Mechanical Ventilation
  • Lung Injury
  • Prospective Observational Study
  • Pressure Support
  • Ideal Body Weight

Background

Use of 'lung-protective' MV (by applying small Vt) is recommended in acute lung injury/acute respiratory distress syndrome (ALI/ARDS) patients. Animal studies suggest that such strategies may also prevent ventilator-associated lung injury in patients with healthy lungs.

Methods

To evaluate how MV is applied in ICU patients in The Netherlands, we performed a prospective observational study in an academic ICU and two non-academic ICUs. MV settings (mode, actually applied Vt and total PEEP) were collected three times per day. A total of 43 consecutive admitted ICU patients (24 with ALI/ARDS) were studied. To determine the ideal Vt, the ideal body weight was calculated from patients' length. Data are means (± SD).

Statistical analysis

Mann–Whitney U test. P < 0.05 was considered statistically significant.

Results

Pressure-controlled or pressure support MV modes were most often used (97.7%). No differences were seen between the four MV modes (ASV, IPPV, ASB and PC) with respect to applied Vt and PEEP. Higher levels of PEEP were used in ARDS patients (P = 0.002). Importantly, in the majority of patients Vt was > 8 ml/kg. Moreover, Vt was significantly higher in ARDS patients than in non-ARDS patients (P = 0.002).

Conclusion

There is a large discrepancy between ideal Vt and actually applied Vt. A possible explanation is the use of absolute bodyweight instead of ideal bodyweight for calculation of Vt. Implementation of small Vt–MV needs an educational program and evaluation, which is currently in progress in all three ICUs.

Table 1

 

ALI/ARDS

Non-ALI/ARDS

Hospital

Vt

% > 8 ml/kg

PEEP

Vt

% > 8 ml/kg

PEEP

I (n = 91)

9.3 (2.0)

75.9

8.6 (4.3)

10.3 (2.7)

77.7

6.8 (3.4)

II (n = 81)

11.6 (1.8)

98.2

11.1 (3.9)

9.9 (1.4)

91.7

9.3 (2.9)

III (n = 84)

10.6 (3.4)

76.7

13.7 (4.3)

9.2 (2.0)

68.3

11.0 (3.6)

All (n = 256)

10.5 (2.6)

84.4

11.0 (4.6)

9.7 (2.3)

77.5

9.1 (3.8)

Authors’ Affiliations

(1)
Academic Medical Centre, Amsterdam, The Netherlands
(2)
Gelre Hospital, Apeldoorn, The Netherlands
(3)
Medical Centre Leeuwarden, The Netherlands

Copyright

© BioMed Central Ltd. 2004

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