Ventilator settings as a risk factor for acute respiratory distress syndrome in mechanically ventilated patients
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 patie...
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Veröffentlicht in: | Intensive care medicine 2005-07, Vol.31 (7), p.922-926 |
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description | 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.
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.
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).
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. |
doi_str_mv | 10.1007/s00134-005-2625-1 |
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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.
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).
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.</description><identifier>ISSN: 0342-4642</identifier><identifier>EISSN: 1432-1238</identifier><identifier>DOI: 10.1007/s00134-005-2625-1</identifier><identifier>PMID: 15856172</identifier><identifier>CODEN: ICMED9</identifier><language>eng</language><publisher>Heidelberg: Springer</publisher><subject>Acute respiratory distress syndrome ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Bacterial pneumonia ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Care and treatment ; Case studies ; Causes of ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Emergency and intensive respiratory care ; Female ; Humans ; Hypotheses ; Intensive care medicine ; Logistic Models ; Male ; Medical sciences ; Middle Aged ; Multicenter Studies as Topic ; Physiology ; Pneumonia ; Positive-Pressure Respiration ; Respiration, Artificial - adverse effects ; Respiratory distress syndrome ; Respiratory Distress Syndrome, Adult - classification ; Respiratory Distress Syndrome, Adult - etiology ; Respiratory therapy ; Retrospective Studies ; Risk Factors ; Sepsis ; Severity of Illness Index ; Tidal Volume ; Trauma ; Ventilators</subject><ispartof>Intensive care medicine, 2005-07, Vol.31 (7), p.922-926</ispartof><rights>2005 INIST-CNRS</rights><rights>COPYRIGHT 2005 Springer</rights><rights>Springer-Verlag 2005</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c570t-872a86e0f3c221289d04ce7e40f3089a05b14ddab0ab30e24c7336a253f1fa153</citedby><cites>FETCH-LOGICAL-c570t-872a86e0f3c221289d04ce7e40f3089a05b14ddab0ab30e24c7336a253f1fa153</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,781,785,27929,27930</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16920362$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15856172$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>GAJIC, Ognjen</creatorcontrib><creatorcontrib>FRUTOS-VIVAR, Fernando</creatorcontrib><creatorcontrib>ESTEBAN, André</creatorcontrib><creatorcontrib>HUBMAYR, Rolf D</creatorcontrib><creatorcontrib>ANZUETO, Antonio</creatorcontrib><title>Ventilator settings as a risk factor for acute respiratory distress syndrome in mechanically ventilated patients</title><title>Intensive care medicine</title><addtitle>Intensive Care Med</addtitle><description>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.
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.
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).
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.</description><subject>Acute respiratory distress syndrome</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Bacterial pneumonia</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>Care and treatment</subject><subject>Case studies</subject><subject>Causes of</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Emergency and intensive respiratory care</subject><subject>Female</subject><subject>Humans</subject><subject>Hypotheses</subject><subject>Intensive care medicine</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multicenter Studies as Topic</subject><subject>Physiology</subject><subject>Pneumonia</subject><subject>Positive-Pressure Respiration</subject><subject>Respiration, Artificial - adverse effects</subject><subject>Respiratory distress syndrome</subject><subject>Respiratory Distress Syndrome, Adult - classification</subject><subject>Respiratory Distress Syndrome, Adult - etiology</subject><subject>Respiratory therapy</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Sepsis</subject><subject>Severity of Illness Index</subject><subject>Tidal Volume</subject><subject>Trauma</subject><subject>Ventilators</subject><issn>0342-4642</issn><issn>1432-1238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNptkl2L1TAQhoMo7tnVH-CNBGW965pJmrS9XBa_YMEb9TbMSafHrG1ak1Y4_96UU1iUQxLCTJ53mCQvY69A3IAQ1fskBKiyEEIX0khdwBO2g1LJAqSqn7KdUKUsSlPKC3aZ0kOmK6PhObsAXWsDldyx6QeF2fc4j5EnmmcfDoljnjz69It36NaTLi90y0w8Upp8XPEjb32ac5x4OoY2jgNxH_hA7icG77Dvj_zPVpxaPuHsc5ResGcd9olebvsV-_7xw7e7z8X9109f7m7vC6crMRd1JbE2JDrlpARZN60oHVVU5oyoGxR6D2Xb4l7gXgmSpauUMii16qBD0OqKvTvVneL4e6E028EnR32PgcYlWVM1NZiyyuCb_8CHcYkh92YlGAmQXypDb0_QAXuyPnTjHNGtFe0taKgbpWSTqeIMdaBAEfsxUOdz-h_-5gyfR0uDd2cFcBK4OKYUqbNT9APGowVhV0vYkyVstoRdLWHX1l9v91v2A7WPis0DGbjeAEz527qIwfn0yJlGCmWk-gu6gb2G</recordid><startdate>20050701</startdate><enddate>20050701</enddate><creator>GAJIC, Ognjen</creator><creator>FRUTOS-VIVAR, Fernando</creator><creator>ESTEBAN, André</creator><creator>HUBMAYR, Rolf D</creator><creator>ANZUETO, Antonio</creator><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20050701</creationdate><title>Ventilator settings as a risk factor for acute respiratory distress syndrome in mechanically ventilated patients</title><author>GAJIC, Ognjen ; FRUTOS-VIVAR, Fernando ; ESTEBAN, André ; HUBMAYR, Rolf D ; ANZUETO, Antonio</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c570t-872a86e0f3c221289d04ce7e40f3089a05b14ddab0ab30e24c7336a253f1fa153</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Acute respiratory distress syndrome</topic><topic>Anesthesia. 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Miscellaneous</topic><topic>Emergency and intensive respiratory care</topic><topic>Female</topic><topic>Humans</topic><topic>Hypotheses</topic><topic>Intensive care medicine</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multicenter Studies as Topic</topic><topic>Physiology</topic><topic>Pneumonia</topic><topic>Positive-Pressure Respiration</topic><topic>Respiration, Artificial - adverse effects</topic><topic>Respiratory distress syndrome</topic><topic>Respiratory Distress Syndrome, Adult - classification</topic><topic>Respiratory Distress Syndrome, Adult - etiology</topic><topic>Respiratory therapy</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Sepsis</topic><topic>Severity of Illness Index</topic><topic>Tidal Volume</topic><topic>Trauma</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>GAJIC, Ognjen</creatorcontrib><creatorcontrib>FRUTOS-VIVAR, Fernando</creatorcontrib><creatorcontrib>ESTEBAN, André</creatorcontrib><creatorcontrib>HUBMAYR, Rolf D</creatorcontrib><creatorcontrib>ANZUETO, Antonio</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>GAJIC, Ognjen</au><au>FRUTOS-VIVAR, Fernando</au><au>ESTEBAN, André</au><au>HUBMAYR, Rolf D</au><au>ANZUETO, Antonio</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ventilator settings as a risk factor for acute respiratory distress syndrome in mechanically ventilated patients</atitle><jtitle>Intensive care medicine</jtitle><addtitle>Intensive Care Med</addtitle><date>2005-07-01</date><risdate>2005</risdate><volume>31</volume><issue>7</issue><spage>922</spage><epage>926</epage><pages>922-926</pages><issn>0342-4642</issn><eissn>1432-1238</eissn><coden>ICMED9</coden><abstract>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.
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.
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).
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.</abstract><cop>Heidelberg</cop><cop>Berlin</cop><pub>Springer</pub><pmid>15856172</pmid><doi>10.1007/s00134-005-2625-1</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Acute respiratory distress syndrome Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Bacterial pneumonia Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Care and treatment Case studies Causes of Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Emergency and intensive respiratory care Female Humans Hypotheses Intensive care medicine Logistic Models Male Medical sciences Middle Aged Multicenter Studies as Topic Physiology Pneumonia Positive-Pressure Respiration Respiration, Artificial - adverse effects Respiratory distress syndrome Respiratory Distress Syndrome, Adult - classification Respiratory Distress Syndrome, Adult - etiology Respiratory therapy Retrospective Studies Risk Factors Sepsis Severity of Illness Index Tidal Volume Trauma Ventilators |
title | Ventilator settings as a risk factor for acute respiratory distress syndrome in mechanically ventilated patients |
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