{"id":25571,"date":"2024-04-16T04:56:00","date_gmt":"2024-04-15T20:56:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=25571"},"modified":"2024-04-16T05:42:57","modified_gmt":"2024-04-15T21:42:57","slug":"chest%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e5%8c%97%e7%be%8e%e5%92%8c%e8%8b%b1%e5%9b%bdicu%e6%82%a3%e8%80%85%e4%b8%ad%e5%ae%9e%e6%96%bd%e5%b0%8f%e6%bd%ae%e6%b0%94%e9%87%8f%e9%80%9a%e6%b0%94","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=25571","title":{"rendered":"[Chest\u53d1\u8868\u8bba\u6587]\uff1a\u5317\u7f8e\u548c\u82f1\u56fdICU\u60a3\u8005\u4e2d\u5b9e\u65bd\u5c0f\u6f6e\u6c14\u91cf\u901a\u6c14\u7684\u60c5\u51b5\u5f88\u5dee"},"content":{"rendered":"\n

CRITICAL CARE: ORIGINAL RESEARCH|\u00a0VOLUME 165, ISSUE 2<\/a>,\u00a0P333-347,\u00a0FEBRUARY 2024<\/p>\n\n\n\n

Low Tidal Volume Ventilation Is Poorly Implemented for Patients in North American and United Kingdom ICUs Using Electronic Health Records<\/h1>\n\n\n\n

Romit J. Samanta, Ari Ercole, Steven Harris, et al<\/a><\/h3>\n\n\n\n

Chest 2024; 165: 333-347 Published:September 27, 2023 DOI:https:\/\/doi.org\/10.1016\/j.chest.2023.09.021<\/a><\/h3>\n\n\n\n

Background<\/h3>\n\n\n\n

Low tidal volume ventilation (LTVV; < 8 mL\/kg predicted body weight [PBW]) is a well-established standard of care associated with improved outcomes. This study used data collated in multicenter electronic health record ICU databases from the United Kingdom and the United States to analyze the use of LTVV in routine clinical practice.<\/p>\n\n\n\n

Research Question<\/h3>\n\n\n\n

What factors are associated with adherence to LTVV in the United Kingdom and North America?<\/p>\n\n\n\n

Study Design<\/h3>\n\n\n\n

This was a retrospective, multicenter study across the United Kingdom and United States of patients who were mechanically ventilated.<\/p>\n\n\n\n

Methods<\/h3>\n\n\n\n

Factors associated with adherence to LTVV were assessed in all patients in both databases who were mechanically ventilated for > 48 h. We observed trends over time and investigated whether LTVV was associated with patient outcomes (30-day mortality and duration of ventilation) and identified strategies to improve adherence to LTVV.<\/p>\n\n\n\n

Results<\/h3>\n\n\n\n

A total of 5,466 (Critical Care Health Informatics Collaborative [CCHIC]) and 7,384 electronic ICU collaborative research database [eICU-CRD] patients were ventilated for > 48\u00a0h and had data of suitable quality for analysis. The median tidal volume (VT<\/sub>) values were 7.48\u00a0mL\/kg PBW (CCHIC) and 7.91\u00a0mL\/kg PBW (eICU-CRD). The patients at highest risk of not receiving LTVV were shorter than 160\u00a0cm (CCHIC) and 165\u00a0cm (eICU-CRD). Those with BMI > 30\u00a0kg\/m2<\/sup>\u00a0(CCHIC OR, 1.9 [95%\u00a0CI, 1.7-2.13]; eICU-CRD OR, 1.61 [95%\u00a0CI, 1.49-1.75]) and female patients (CCHIC OR, 2.39 [95%\u00a0CI, 2.16-2.65]; eICU-CRD OR, 2.29 [95%\u00a0CI, 2.26-2.31]) were at increased risk of having median VT<\/sub>\u00a0> 8\u00a0mL\/kg PBW. Patients with median VT<\/sub>\u00a0< 8\u00a0mL\/kg PBW had decreased 30-day mortality in the CCHIC database (CCHIC cause-specific hazard ratio, 0.86 [95%\u00a0CI, 0.76-0.97]; eICU-CRD cause-specific hazard ratio, 0.9 [95%\u00a0CI, 0.86-1.00]). There was a significant reduction in VT<\/sub>\u00a0over time in the CCHIC database.<\/p>\n\n\n\n

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Interpretation<\/h3>\n\n\n\n

There has been limited implementation of LTVV in routine clinical practice in the United Kingdom and the United States. VT<\/sub>> 8 mL\/kg PBW was associated with worse patient outcomes.<\/p>\n","protected":false},"excerpt":{"rendered":"

CRITICAL CARE: ORIGINAL RESEARCH|\u00a0VOLUME 165, ISSUE 2,\u00a0 […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25571"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=25571"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25571\/revisions"}],"predecessor-version":[{"id":25572,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25571\/revisions\/25572"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=25571"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=25571"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=25571"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}