Accurate Tidal Volume for Patients under Mechanical Ventilation: A Cross-sectional Descriptive Study
Abstract
Background: In order to prevent lung injury among patients under mechanical ventilation, tidal volume should be determined based on predicted body weight. The aim of the study was to determine the accuracy of tidal volume determination for patients under mechanical ventilation and to assess nurses’ knowledge about accurate tidal volume determination.
Methods: This was a cross-sectional descriptive study. This study was conducted on 250 patients under mechanical ventilation and 75 nurses who provided care to the patients. Patients’ height was estimated based on their ulna length and then, their predicted body weight and tidal volume were estimated. Nurses’ knowledge about tidal volume determination was also assessed.
Results: The mean of delivered tidal volume was 9.1±1.73 mL/kg of predicted body weight. Tidal volume for 172 patients (68.8%) had been set at more than 8 mL/kg of predicted body weight. Forty nine nurses (65.3%) noted that there was no guideline in their wards for height and weight measurement. They determined patients’ weight and height through either visual estimation (21 nurses; 28.0%) or asking from their colleagues, patients, or patients’ family members (48 nurses; 64.0%).
Conclusion: Nurses have limited knowledge about accurate tidal volume determination and hence, deliver high tidal volume to patients under mechanical ventilation which puts them at risk for ventilator-associated lung injury. Urgent interventions such as lung-protective strategies, staff training, and careful managerial supervision are needed to prevent ventilator-associated lung injury and improve patient safety.
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[2] Lagu T, Zilberberg MD, Tjia J, Pekow PS, Lindenauer PK. Use of Mechanical Ventilation by Patients With and Without Dementia, 2001 Through 2011. JAMA Intern Med. 2014; 174(6):999-1001.
[3] Nota C, Santamaria JD, Reid D, Tobin AE. The impact of an education program and written guideline on adherence to low tidal volume ventilation. Crit Care Resusc. 2016; 18(3):174-80.
[4] Davies JD, Senussi MH, Mireles-Cabodevila E. Should A Tidal Volume of 6 mL/kg Be Used in All Patients? Respir Care. 2016; 61(6): 774-790.
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[6] Sutherasan Y, D'Antini D, Pelosi P. Advances in ventilator-associated lung injury: prevention is the target. Expert Rev Respir Med. 2014; 8(2):233-48.
[7] Kuchnicka K, Maciejewski D. Ventilator-associated lung injury. Anaesthesiol Intensive Ther. 2013;45(3):164-70.
[8] Castellanos I, Martin M, Kraus S, Bürkle T, Prokosch H-U, Schüttler J, Toddenroth D. Effects of staff training and electronic event monitoring on long-term adherence to lung-protective ventilation recommendations. J Crit Care. 2018; 43:13-20.
[9] Mohr N, Fuller B. Low tidal volume ventilation should be the routine ventilation strategy of choice for all emergency department patients. Ann Emerg Med. 2012; 60(2):215-6.
[10] Slutsky AS, Ranieri VM. Ventilator-Induced Lung Injury. N Engl J Med. 2013; 369(22):2126-36.
[11] Needham DM, Yang T, Dinglas VD, Mendez-Tellez PA, Shanholtz C, Sevransky JE, et al. Timing of Low Tidal Volume Ventilation and Intensive Care Unit Mortality in Acute Respiratory Distress Syndrome. A Prospective Cohort Study. Am J Respir Crit Care Med. 2015; 191(2):177-85.
[12] Needham DM, Colantuoni E, Mendez-Tellez PA, Dinglas VD, Sevransky JE, Dennison Himmelfarb CR, et al. Lung protective mechanical ventilation and two year survival in patients with acute lung injury: prospective cohort study. BMJ. 2012; 344:e2124.
[13] Kimura S, Stoicea N, Rosero Britton BR, Shabsigh M, Branstiter A, Stahl DL. Preventing Ventilator-Associated Lung Injury: A Perioperative Perspective. Front Med. 2016; 3:25.
[14] Sasko B, Thiem U, Christ M, Trappe H-J, Ritter O, Pagonas N. Size matters: An observational study investigating estimated height as a reference size for calculating tidal volumes if low tidal volume ventilation is required. PloS One. 2018; 13(6):e0199917.
[15] Ioannidis G, Lazaridis G, Baka S, Mpoukovinas I, Karavasilis V, Lampaki S, et al. Barotrauma and pneumothorax. J Thorac Dis. 2015;7(Suppl 1):S38-S43.
[16] Sjoding MW, Gong MN, Haas CF, Iwashyna TJ. Evaluating delivery of low tidal volume ventilation in six ICUs using electronic health record data. Crit Care Med. 2019; 47(1):56-61.
[17] Linares-Perdomo O, East TD, Brower R, Morris AH. Standardizing predicted body weight equations for mechanical ventilation tidal volume settings. Chest. 2015; 148(1):73-8.
[18] O'Brien DE, Kam JK, Slater RJ, Tobin AE. A novel biometric approach to estimating tidal volume. Crit Care Resusc. 2019; 21(1): 25-31.
[19] Wolthuis EK, Kesecioglu J, Hassink LH, Determann RM, Korevaar JC, Schultz MJ. Adoption of Lower Tidal Volume Ventilation Improves With Feedback and Education. Respir Care. 2007; 52(12): 1761-6.
[20] Soares FRR, Moreira DAA, Uchôa IMA, Lima KPAd, Silva MLHMCd, Alves TEdA. Mechanical ventilation: technical and scientific knowledge of nursing professionals in intensive care units. J Nurs UFPE on line. 2012; 6(4):735-41.
[21] Mohammed SJ, Hammod HJ. Effectiveness of an Educational Program on Nurses Knowledge Concerning Complications Prevention of Mechanical Ventilation at Intensive Care Unit in Al-Hussain Teaching Hospital at Nassiryah City. kufa Journal for Nursing sciences. 2016; 6(2): 1-11. Available at: http://www.journals.uokufa.edu.iq/index.php/kjns/article/view/5008.
[22] O’Brien ID, Shacklock E, Middleditch A, Bigham C. Inaccuracies in calculating predicted body weight and its impact on safe ventilator settings. J Intensive Care Soc. 2016; 17(3):191-5.
[23] Pinheiro de Oliveira R, Hetzel MP, dos Anjos Silva M, Dallegrave D, Friedman G. Mechanical ventilation with high tidal volume induces inflammation in patients without lung disease. Crit Care. 2010; 14(2):R39.
[24] Sutherasan Y, Vargas M, Pelosi P. Protective mechanical ventilation in the non-injured lung: review and meta-analysis. Crit Care. 2014; 18(2):211.
[25] Wolthuis EK, Korevaar JC, Spronk P, Kuiper MA, Dzoljic M, Vroom MB, Schultz MJ. Feedback and education improve physician compliance in use of lung-protective mechanical ventilation. Intensive Care Med. 2005; 31(4):540-6.
[26] Newell CP, Martin MJ, Richardson N, Bourdeaux CP. Protective mechanical ventilation in United Kingdom critical care units: A multicentre audit. J Intensive Care Soc. 2017; 18(2):106-12.
[27] Prekker ME, Donelan C, Ambur S, Driver BE, O'Brien-Lambert A, Hottinger DG, et al. Adoption of low tidal volume ventilation in the emergency department: A quality improvement intervention. Am J Emerg Med. 2019; 38(4):763-7.
[28] Kam EPY, Eslick GD, James A, Benson JP. Acute respiratory distress syndrome (ARDS) and low tidal volume ventilation: the debate about weight. Intensive Care Med. 2004; 30(7):1502.
[29] Holden S, Nichani R. Low tidal volume ventilation. J Intensive Care Soc. 2018; 19(2):171-2.
[30] Leary TS, Milner QJW, Niblett DJ. The accuracy of the estimation of body weight and height in the intensive care unit. Eur J Anaesthesiol. 2000; 17(11):698-703.
[31] Deane AM, Reid DA, Tobin AE. Predicted body weight during mechanical ventilation: using arm demispan to aid clinical assessment. Crit Care Resusc. 2008; 10(1):9-14.
[32] Kalánková D, Žiaková K, Kurucová R. Approaches to understanding the phenomenon of missed/rationed/unfinished care–a literature review. Central Eur J Nurs Midwifery. 2019;10(1):1005-16.
[33] Bragadóttir H, Kalisch BJ, Tryggvadóttir GB. Correlates and predictors of missed nursing care in hospitals. J Clin Nurs. 2017; 26(11-12):1524-34.
[34] Jones TL, Hamilton P, Murry N. Unfinished nursing care, missed care, and implicitly rationed care: State of the science review. Int J Nurs Stud. 2015; 52(6):1121-37.
[2] Lagu T, Zilberberg MD, Tjia J, Pekow PS, Lindenauer PK. Use of Mechanical Ventilation by Patients With and Without Dementia, 2001 Through 2011. JAMA Intern Med. 2014; 174(6):999-1001.
[3] Nota C, Santamaria JD, Reid D, Tobin AE. The impact of an education program and written guideline on adherence to low tidal volume ventilation. Crit Care Resusc. 2016; 18(3):174-80.
[4] Davies JD, Senussi MH, Mireles-Cabodevila E. Should A Tidal Volume of 6 mL/kg Be Used in All Patients? Respir Care. 2016; 61(6): 774-790.
[5] Gattinoni L, Tonetti T, Quintel M. Intensive care medicine in 2050: ventilator-induced lung injury. Intensive Care Med. 2018; 44(1):76-8.
[6] Sutherasan Y, D'Antini D, Pelosi P. Advances in ventilator-associated lung injury: prevention is the target. Expert Rev Respir Med. 2014; 8(2):233-48.
[7] Kuchnicka K, Maciejewski D. Ventilator-associated lung injury. Anaesthesiol Intensive Ther. 2013;45(3):164-70.
[8] Castellanos I, Martin M, Kraus S, Bürkle T, Prokosch H-U, Schüttler J, Toddenroth D. Effects of staff training and electronic event monitoring on long-term adherence to lung-protective ventilation recommendations. J Crit Care. 2018; 43:13-20.
[9] Mohr N, Fuller B. Low tidal volume ventilation should be the routine ventilation strategy of choice for all emergency department patients. Ann Emerg Med. 2012; 60(2):215-6.
[10] Slutsky AS, Ranieri VM. Ventilator-Induced Lung Injury. N Engl J Med. 2013; 369(22):2126-36.
[11] Needham DM, Yang T, Dinglas VD, Mendez-Tellez PA, Shanholtz C, Sevransky JE, et al. Timing of Low Tidal Volume Ventilation and Intensive Care Unit Mortality in Acute Respiratory Distress Syndrome. A Prospective Cohort Study. Am J Respir Crit Care Med. 2015; 191(2):177-85.
[12] Needham DM, Colantuoni E, Mendez-Tellez PA, Dinglas VD, Sevransky JE, Dennison Himmelfarb CR, et al. Lung protective mechanical ventilation and two year survival in patients with acute lung injury: prospective cohort study. BMJ. 2012; 344:e2124.
[13] Kimura S, Stoicea N, Rosero Britton BR, Shabsigh M, Branstiter A, Stahl DL. Preventing Ventilator-Associated Lung Injury: A Perioperative Perspective. Front Med. 2016; 3:25.
[14] Sasko B, Thiem U, Christ M, Trappe H-J, Ritter O, Pagonas N. Size matters: An observational study investigating estimated height as a reference size for calculating tidal volumes if low tidal volume ventilation is required. PloS One. 2018; 13(6):e0199917.
[15] Ioannidis G, Lazaridis G, Baka S, Mpoukovinas I, Karavasilis V, Lampaki S, et al. Barotrauma and pneumothorax. J Thorac Dis. 2015;7(Suppl 1):S38-S43.
[16] Sjoding MW, Gong MN, Haas CF, Iwashyna TJ. Evaluating delivery of low tidal volume ventilation in six ICUs using electronic health record data. Crit Care Med. 2019; 47(1):56-61.
[17] Linares-Perdomo O, East TD, Brower R, Morris AH. Standardizing predicted body weight equations for mechanical ventilation tidal volume settings. Chest. 2015; 148(1):73-8.
[18] O'Brien DE, Kam JK, Slater RJ, Tobin AE. A novel biometric approach to estimating tidal volume. Crit Care Resusc. 2019; 21(1): 25-31.
[19] Wolthuis EK, Kesecioglu J, Hassink LH, Determann RM, Korevaar JC, Schultz MJ. Adoption of Lower Tidal Volume Ventilation Improves With Feedback and Education. Respir Care. 2007; 52(12): 1761-6.
[20] Soares FRR, Moreira DAA, Uchôa IMA, Lima KPAd, Silva MLHMCd, Alves TEdA. Mechanical ventilation: technical and scientific knowledge of nursing professionals in intensive care units. J Nurs UFPE on line. 2012; 6(4):735-41.
[21] Mohammed SJ, Hammod HJ. Effectiveness of an Educational Program on Nurses Knowledge Concerning Complications Prevention of Mechanical Ventilation at Intensive Care Unit in Al-Hussain Teaching Hospital at Nassiryah City. kufa Journal for Nursing sciences. 2016; 6(2): 1-11. Available at: http://www.journals.uokufa.edu.iq/index.php/kjns/article/view/5008.
[22] O’Brien ID, Shacklock E, Middleditch A, Bigham C. Inaccuracies in calculating predicted body weight and its impact on safe ventilator settings. J Intensive Care Soc. 2016; 17(3):191-5.
[23] Pinheiro de Oliveira R, Hetzel MP, dos Anjos Silva M, Dallegrave D, Friedman G. Mechanical ventilation with high tidal volume induces inflammation in patients without lung disease. Crit Care. 2010; 14(2):R39.
[24] Sutherasan Y, Vargas M, Pelosi P. Protective mechanical ventilation in the non-injured lung: review and meta-analysis. Crit Care. 2014; 18(2):211.
[25] Wolthuis EK, Korevaar JC, Spronk P, Kuiper MA, Dzoljic M, Vroom MB, Schultz MJ. Feedback and education improve physician compliance in use of lung-protective mechanical ventilation. Intensive Care Med. 2005; 31(4):540-6.
[26] Newell CP, Martin MJ, Richardson N, Bourdeaux CP. Protective mechanical ventilation in United Kingdom critical care units: A multicentre audit. J Intensive Care Soc. 2017; 18(2):106-12.
[27] Prekker ME, Donelan C, Ambur S, Driver BE, O'Brien-Lambert A, Hottinger DG, et al. Adoption of low tidal volume ventilation in the emergency department: A quality improvement intervention. Am J Emerg Med. 2019; 38(4):763-7.
[28] Kam EPY, Eslick GD, James A, Benson JP. Acute respiratory distress syndrome (ARDS) and low tidal volume ventilation: the debate about weight. Intensive Care Med. 2004; 30(7):1502.
[29] Holden S, Nichani R. Low tidal volume ventilation. J Intensive Care Soc. 2018; 19(2):171-2.
[30] Leary TS, Milner QJW, Niblett DJ. The accuracy of the estimation of body weight and height in the intensive care unit. Eur J Anaesthesiol. 2000; 17(11):698-703.
[31] Deane AM, Reid DA, Tobin AE. Predicted body weight during mechanical ventilation: using arm demispan to aid clinical assessment. Crit Care Resusc. 2008; 10(1):9-14.
[32] Kalánková D, Žiaková K, Kurucová R. Approaches to understanding the phenomenon of missed/rationed/unfinished care–a literature review. Central Eur J Nurs Midwifery. 2019;10(1):1005-16.
[33] Bragadóttir H, Kalisch BJ, Tryggvadóttir GB. Correlates and predictors of missed nursing care in hospitals. J Clin Nurs. 2017; 26(11-12):1524-34.
[34] Jones TL, Hamilton P, Murry N. Unfinished nursing care, missed care, and implicitly rationed care: State of the science review. Int J Nurs Stud. 2015; 52(6):1121-37.
| Files | ||
| Issue | Vol 6 No 4 (2020): Autumn |
|
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v6i4.4631 | |
| Keywords | ||
| Mechanical ventilation Tidal volume Body weight Nurses knowledge | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Sayadi L, Ghiyasvandian S, Karimi Rozveh A, Norouzrajabi S. Accurate Tidal Volume for Patients under Mechanical Ventilation: A Cross-sectional Descriptive Study. Arch Anesth & Crit Care. 2020;6(4):175-181.
