Low-tidal volume mechanical ventilation in patients with acute respiratory distress syndrome caused by pandemic influenza A/H1N1 infection.

Abstract

PURPOSE:

Low-tidal volume (TV) mechanical ventilation is an important manipulation in managing patients with acute respiratory distress syndrome (ARDS). However, there is no definite evidence to support the use of this intervention in patients with viral etiologies.

MATERIALS AND METHODS:

A retrospective observational study of 104 patients with ARDS caused by pandemic influenza A/H1N1 infection admitted to 28 intensive care units (ICUs) in Korea was performed. Patients were categorized into 3 groups according to the TV they received: TV less than or equal to 7 mL/kg, TV greater than 7 mL/kg but less than or equal to 9 mL/kg, or TV greater than 9 mL/kg.

RESULTS:

The mean age was 55.1 years, and 55.8% were male (n = 58). Patients with TV greater than 9 mL/kg showed higher 28-day ICU mortality than the 2 other groups (vs TV < 7 mL/kg, P = .007 and vs 7 mL/kg < TV ≤ 9 mL/kg, P = .004, respectively). Patients with TV less than or equal to 7 mL/kg required ventilators, ICU admissions, and hospitalizations for fewer days than those with TV greater than 7 mL/kg (11.4 vs 6.1 days for 28-day ventilator-free days, 9.7 vs 4.9 days for 28-day ICU-free days, and 5.2 vs 2.4 days for 28-day hospital-free days, respectively). Tidal volume greater than 9 mL/kg (hazard rate, 2.459; P = .003) and Sequential Organ Failure Assessment score (hazard rate, 1.158; P = .014) were significant predictors of 28-day ICU mortality.

CONCLUSIONS:

Low-TV mechanical ventilation still benefits patients with ARDS caused by viral pneumonia.

• Authors: Dong Kyu Oh, Myung Goo Lee, Eun Young Choi, Jaemin Lim, Hyun-Kyung Lee, Seok Chan Kim, Chae-Man Lim, Younsuck Koh, Sang-Bum Hong, Korean Society of Critical Care Medicine H1N1 collaborative
• Journal: Journal of critical care (J Crit Care) Vol. 28 Issue 4 Pg. 358-64 (Aug 2013) ISSN: 1557-8615 [Electronic] United States
• PMID: 23602273 (Publication Type: Journal Article)
• Copyright: Copyright © 2013 Elsevier Inc. All rights reserved.

Topics

• Chi-Square Distribution
• Female
• Hospital Mortality
• Humans
• Influenza A Virus, H1N1 Subtype
• Influenza, Human (epidemiology, physiopathology, therapy, virology)
• Intensive Care Units
• Male
• Middle Aged
• Pandemics
• Republic of Korea (epidemiology)
• Respiration, Artificial (methods)
• Respiratory Distress Syndrome (epidemiology, physiopathology, therapy, virology)
• Retrospective Studies
• Risk Factors
• Statistics, Nonparametric
• Survival Rate
• Tidal Volume
• Treatment Outcome