Lung protective mechanical ventilation strategies in Cardiothoracic Critical Care: A retrospective study
CCCF ePoster library. Hague M. Nov 2, 2016; 150983; 102 Disclosure(s): None
Dr. Matthew Hague
Dr. Matthew Hague
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Topic: Retrospective or Prospective Cohort Study

Lung protective mechanical ventilation strategies in Cardiothoracic Critical Care: A retrospective study


Zochios Vasileios1,2, Hague Matthew2, Giraud Kimberly2, Jones Nicola2

1University Hospitals of Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmimgham, Intensive Care Unit, College of Medical and Dental Sciences Unversity of Birmingham, Birmingham UK, 2Papworth Hospital NHS Foundation Trust, Intensive Care Unit, Research and Development Department, Papworth Everard, Cambridge, UK



Abstract:

Introduction: A body of evidence supports the use of low tidal volumes in ventilated patients without lung pathology to slow/halt progress to acute respiratory distress syndrome (ARDS) due to ventilator associated lung injury (VALI)[1]. Patients undergoing cardiac surgery are particularly sensitive to lung damage due to prolonged mechanical ventilation, multiple co-morbidities and pro-inflammatory cofactors (cardiopulmonary bypass, transfusions, ischaemia/reperfusion).
 
Objectives: To test the hypothesis that low tidal volume ventilation is an independent predictor of mortality in cardiothoracic critical care patients.
 
Methods: We performed a retrospective database analysis of patients >18 years admitted to Papworth Hospital cardiothoracic intensive care unit (ICU) between 01/01/2015 and 15/08/2015 requiring mechanical ventilation (MV) for >48 hours (n=189). Predictor variables in the first 24 hours extracted from Papworth clinical information system included Sequential Organ Failure Assessment (SOFA) score at the onset of MV, ventilator mode, tidal volume (Vt), respiratory rate, positive end-expiratory pressure (PEEP), FiO2, pH, PaO2, PaCO2, peak airway pressure (Ppk), compliance (Cdyn), PaO2/FiO2 ratio, albumin, bilirubin, Fluid Balance, [H+], and type of surgery (Cardiac/Thoracic, Transplant, Non-surgical). Outcome variables included ICU and 90 day mortality. Multiple logistic/linear regressions and adjusting for covariates, identified independent significant predictors for outcome variables.
Results: When controlling for covariates, Vt and other ventilator variables did not independently predict mortality in our model, despite best evidence suggesting that they should.

Conclusions: Independent predictors of mortality in our study included: type of surgery, albumin, H+, bilirubin and fluid balance. In particular, it is important to note that cardiac, thoracic and transplant surgical patients were associated with lower mortality. However, our study does not sample equally from The Berlin Definition of ARDS severity categories (mild, moderate and severe hypoxaemia) [2]. Although our study was not adequately powered to detect a difference in mortality between these groups it will inform the development of a large prospective cohort study exploring the role of low tidal volume ventilation in cardiothoracic critically ill patients.
 


References:

1. Neto AS, Cardoso SO, Manetta JA, et al. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA 2012; 308.
2. The ARDS Definition Task Force*. Acute Respiratory Distress Syndrome: The Berlin Definition. JAMA. 2012;307(23):2526-2533.  
 



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