Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation

Ognjen Gajic, Saqib I. Dara, Jose L. Mendez, Adebola O. Adesanya, Emir Festic, Sean M. Caples, Rimki Rana, Jennifer St. Sauver, James F. Lymp, Bekele Afessa, Rolf D. Hubmayr

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Abstract

Objective: Although ventilation with small tidal volumes is recommended in patients with established acute lung injury, most others receive highly variable tidal volume aimed in part at normalizing arterial blood gas values. We tested the hypothesis that acute lung injury, which develops after the initiation of mechanical ventilation, is associated with known risk factors for ventilator-induced lung injury such as ventilation with large tidal folume. Design: Retrospective cohort study. Setting: Four intensive care units in a tertiary referral center. Patients: Patients who received invasive mechanical ventilation for ≥48 hrs between January and December 2001. Interventions: None. Measurements and Main Results: The main outcome of interest, acute lung injury, was assessed by independent review of daily digital chest radiographs and arterial blood gases. Ventilator settings, hemodynamics, and acute lung injury risk factors were extracted from the Acute Physiology and Chronic Health Evaluation III database and the patients' medical records. Of 332 patients who did not have acute lung injury from the outset, 80 patients (24%) developed acute lung injury within the first 5 days of mechanical ventilation. When expressed per predicted body weight, women were ventilated with larger tidal volume than men (mean 11.4 vs. 10.4 mL/kg predicted body weight, p < .001) and tended to develop acute lung injury more often (29% vs. 20%, p = .068). In a multivariate analysis, the main risk factors associated with the development of acute lung injury were the use of large tidal volume (odds ratio 1.3 for each mL above 6 mL/kg predicted body weight, p < .001), transfusion of blood products (odds ratio, 3.0; p < 0.001), acidemia (pH < 7.35; odds ratio, 2.0; p = .032) and a history of restrictive lung disease (odds ratio, 3.6; p = .044). Conclusions: The association between the initial tidal volume and the development of acute lung injury suggests that ventilator-associated lung injury may be an important cause of this syndrome. Height and gender should be considered when setting up the ventilator. Strong consideration should be given to limiting large tidal volume, not only in patients with established acute lung injury but also in patients at risk for acute lung injury.

Original languageEnglish (US)
Pages (from-to)1817-1824
Number of pages8
JournalCritical Care Medicine
Volume32
Issue number9
DOIs
StatePublished - Sep 2004

Fingerprint

Acute Lung Injury
Lung Injury
Mechanical Ventilators
Artificial Respiration
Tidal Volume
Odds Ratio
Body Weight
Ventilation
Gases
Ventilator-Induced Lung Injury
APACHE
Tertiary Care Centers
Blood Transfusion
Lung Diseases
Medical Records
Intensive Care Units
Cohort Studies
Thorax
Multivariate Analysis
Retrospective Studies

Keywords

  • Acute respiratory distress syndrome
  • Outcome assessment (health care), pulmonary edema
  • Transfusion-related acute lung injury
  • Ventilator-associated lung injury

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation. / Gajic, Ognjen; Dara, Saqib I.; Mendez, Jose L.; Adesanya, Adebola O.; Festic, Emir; Caples, Sean M.; Rana, Rimki; St. Sauver, Jennifer; Lymp, James F.; Afessa, Bekele; Hubmayr, Rolf D.

In: Critical Care Medicine, Vol. 32, No. 9, 09.2004, p. 1817-1824.

Research output: Contribution to journalArticle

Gajic, Ognjen ; Dara, Saqib I. ; Mendez, Jose L. ; Adesanya, Adebola O. ; Festic, Emir ; Caples, Sean M. ; Rana, Rimki ; St. Sauver, Jennifer ; Lymp, James F. ; Afessa, Bekele ; Hubmayr, Rolf D. / Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation. In: Critical Care Medicine. 2004 ; Vol. 32, No. 9. pp. 1817-1824.
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AU - Dara, Saqib I.

AU - Mendez, Jose L.

AU - Adesanya, Adebola O.

AU - Festic, Emir

AU - Caples, Sean M.

AU - Rana, Rimki

AU - St. Sauver, Jennifer

AU - Lymp, James F.

AU - Afessa, Bekele

AU - Hubmayr, Rolf D.

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N2 - Objective: Although ventilation with small tidal volumes is recommended in patients with established acute lung injury, most others receive highly variable tidal volume aimed in part at normalizing arterial blood gas values. We tested the hypothesis that acute lung injury, which develops after the initiation of mechanical ventilation, is associated with known risk factors for ventilator-induced lung injury such as ventilation with large tidal folume. Design: Retrospective cohort study. Setting: Four intensive care units in a tertiary referral center. Patients: Patients who received invasive mechanical ventilation for ≥48 hrs between January and December 2001. Interventions: None. Measurements and Main Results: The main outcome of interest, acute lung injury, was assessed by independent review of daily digital chest radiographs and arterial blood gases. Ventilator settings, hemodynamics, and acute lung injury risk factors were extracted from the Acute Physiology and Chronic Health Evaluation III database and the patients' medical records. Of 332 patients who did not have acute lung injury from the outset, 80 patients (24%) developed acute lung injury within the first 5 days of mechanical ventilation. When expressed per predicted body weight, women were ventilated with larger tidal volume than men (mean 11.4 vs. 10.4 mL/kg predicted body weight, p < .001) and tended to develop acute lung injury more often (29% vs. 20%, p = .068). In a multivariate analysis, the main risk factors associated with the development of acute lung injury were the use of large tidal volume (odds ratio 1.3 for each mL above 6 mL/kg predicted body weight, p < .001), transfusion of blood products (odds ratio, 3.0; p < 0.001), acidemia (pH < 7.35; odds ratio, 2.0; p = .032) and a history of restrictive lung disease (odds ratio, 3.6; p = .044). Conclusions: The association between the initial tidal volume and the development of acute lung injury suggests that ventilator-associated lung injury may be an important cause of this syndrome. Height and gender should be considered when setting up the ventilator. Strong consideration should be given to limiting large tidal volume, not only in patients with established acute lung injury but also in patients at risk for acute lung injury.

AB - Objective: Although ventilation with small tidal volumes is recommended in patients with established acute lung injury, most others receive highly variable tidal volume aimed in part at normalizing arterial blood gas values. We tested the hypothesis that acute lung injury, which develops after the initiation of mechanical ventilation, is associated with known risk factors for ventilator-induced lung injury such as ventilation with large tidal folume. Design: Retrospective cohort study. Setting: Four intensive care units in a tertiary referral center. Patients: Patients who received invasive mechanical ventilation for ≥48 hrs between January and December 2001. Interventions: None. Measurements and Main Results: The main outcome of interest, acute lung injury, was assessed by independent review of daily digital chest radiographs and arterial blood gases. Ventilator settings, hemodynamics, and acute lung injury risk factors were extracted from the Acute Physiology and Chronic Health Evaluation III database and the patients' medical records. Of 332 patients who did not have acute lung injury from the outset, 80 patients (24%) developed acute lung injury within the first 5 days of mechanical ventilation. When expressed per predicted body weight, women were ventilated with larger tidal volume than men (mean 11.4 vs. 10.4 mL/kg predicted body weight, p < .001) and tended to develop acute lung injury more often (29% vs. 20%, p = .068). In a multivariate analysis, the main risk factors associated with the development of acute lung injury were the use of large tidal volume (odds ratio 1.3 for each mL above 6 mL/kg predicted body weight, p < .001), transfusion of blood products (odds ratio, 3.0; p < 0.001), acidemia (pH < 7.35; odds ratio, 2.0; p = .032) and a history of restrictive lung disease (odds ratio, 3.6; p = .044). Conclusions: The association between the initial tidal volume and the development of acute lung injury suggests that ventilator-associated lung injury may be an important cause of this syndrome. Height and gender should be considered when setting up the ventilator. Strong consideration should be given to limiting large tidal volume, not only in patients with established acute lung injury but also in patients at risk for acute lung injury.

KW - Acute respiratory distress syndrome

KW - Outcome assessment (health care), pulmonary edema

KW - Transfusion-related acute lung injury

KW - Ventilator-associated lung injury

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