Current State of Ventilator Setting and Their Relationship with Mortality Rate in Patients under Mechanical Ventilation: A Cross-Sectional Study
Abstract
Background: Given the importance of implementing lung protective strategies to prevent lung injury caused by ventilators and death of patients, it is necessary to monitor the current condition of hospitals and examine the relationship between the parameters set on the ventilators and patient mortality. This study conducted to determine the current state of ventilator setting and their relationship with mortality rate in patients under mechanical ventilation: a cross-sectional study.
Methods: This is a cross-sectional study that was conducted between June to December 2020 in one of the hospitals affiliated to Tehran University of Medical Sciences. The initial tidal volume set on the ventilator was recorded for 304 patients under mechanical ventilation and then, their heights were measured and their tidal volumes were determined based on the standard formula. Other parameters set on the ventilator as well as systolic and diastolic blood pressures of patients were also recorded and their survival rate was investigated. The data was analyzed by SPSS software, using descriptive statistics and logistic regression model.
Results: Among patients, who were under mechanical ventilation, 77.6% were hospitalized in intensive care units and the rest were hospitalized in general wards. The mean adjusted tidal volume for patients was 472.91 ± 32.13 ml. The mean peak inspiratory pressure and plateau pressure were 28.00±6.98 and 13.88±4.93 CmH2O, respectively. Also, 37.2% of patients died during the hospitalization. The results of adjusted odds ratio based on multivariate logistic regression model for predictors of mortality rate showed that the variables of patients' age [OR=1.040 (1.019-1.062)], the hospital’s general ward in comparison with the ICU [OR=11.379 (5.130-25.240)] and the peak inspiratory pressure [OR=1.072 (1.007-1.141)] had a direct and significant relationship with mortality rate (in all cases P<0.05). Meanwhile, the plateau pressure [OR=0.886 (0.808 -0.972)] had an inverse and significant relationship with mortality rate (P<0.05).
Conclusion: Despite the recommendations regarding lung protective strategies, in some cases, some parameters set in the ventilator are outside the recommended levels, which can effect on patients mortality. So monitoring and controlling the implementation of lung protective strategies and paying attention to controlling pressures set on the ventilator are among measures that should be taken in medical centers in order to prevent lung injuries and maintain patient safety.
[2] Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med. 2014; 370(10):980.
[3] Joseph A, Khan MF, Rajendram R. Strategies to prevent ventilator-associated lung injury in critically Ill patients. Indian Journal of Respiratory Care. 2018;7(1):4.
[4] Archambault PM, St-Onge M. Invasive and noninvasive ventilation in the emergency department. Emerg Med Clin North Am. 2012; 30(2):421-49.
[5] Marret E, Bonnet F. Lung protective ventilation and thoracic anesthesia. J Thorac Dis. 2019; 11(Suppl 9):S1426-S7.
[6] Schmidt GA. Managing Acute Lung Injury. Clinics in chest medicine. 2016; 37(4):647-58.
[7] Castellanos I, Martin M, Kraus S, Bürkle T, Prokosch H-U, Schüttler J, et al. Effects of staff training and electronic event monitoring on long-term adherence to lung-protective ventilation recommendations. J Crit Care. 2018; 43:13-20.
[8] 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.
[9] Spadaro S, Karbing DS, Fogagnolo A, Ragazzi R, Mojoli F, Astolfi L, et al. Simulation training for residents focused on mechanical ventilation: A randomized trial using mannequin-based versus computer-based simulation. Simul Healthc. 2017; 12(6):349.
[10] 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.
[11] Cornish S, Wynne R, Klim S, Kelly A-M. Protective lung strategies: A cross sectional survey of nurses knowledge and use in the emergency department. Australas Emerg Nurs J. 2017; 20(2):87-91.
[12] Gattinoni L, Tonetti T, Quintel M. Intensive care medicine in 2050: ventilator-induced lung injury. Intensive Care Med. 2018; 44(1):76-8.
[13] 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.
[14] Villar J, Martín-Rodríguez C, Domínguez-Berrot AM, Fernández L, Ferrando C, Soler JA, et al. A quantile analysis of plateau and driving pressures: effects on mortality in patients with acute respiratory distress syndrome receiving lung-protective ventilation. Crit Care Med. 2017; 45(5):843-50.
[15] Sundqvist AS, Anderzen-Carlsson A, Nilsson U, Holmefur M. Protective Nursing Advocacy: Translation and Psychometric Evaluation of an Instrument and a Descriptive Study of Swedish Registered Nurse Anesthetists' Beliefs and Actions. J Perianesth Nurs. 2018; 33(1):58-68.
[16] Liu X, Zheng J, Liu K, Baggs JG, Liu J, Wu Y, et al. Hospital nursing organizational factors, nursing care left undone, and nurse burnout as predictors of patient safety: A structural equation modeling analysis. Int J Nurs Stud. 2018; 86:82-9.
[17] Usher K, Woods C, Parmenter G, Hutchinson M, Mannix J, Power T, et al. Self-reported confidence in patient safety knowledge among Australian undergraduate nursing students: a multi-site cross-sectional survey study. Int J Nurs Stud. 2017; 71:89-96.
[18] Norouzrajabi S, Ghiyasvandian S, Jeddian A, Rozveh AK, Sayadi L. Effects of Feedback and Education on Nurses’ Clinical Competence in Mechanical Ventilation and Accurate Tidal Volume Setting. Journal of Iranian Medical Council. 2021; 4(1):30-8.
[19] 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):191-195.
[20] Iwashita Y, Yamashita K, Ikai H, Sanui M, Imai H, Imanaka Y. Epidemiology of mechanically ventilated patients treated in ICU and non-ICU settings in Japan: a retrospective database study. Crit Care. 2018; 22(1):329.
[21] Yasuda H, Nishimura T, Kamo T, Sanui M, Nango E, Abe T, et al. Optimal plateau pressure for patients with acute respiratory distress syndrome: a protocol for a systematic review and meta-analysis with meta-regression. BMJ open. 2017; 7(5):e015091.
[22] Blum JM, Maile M, Park PK, Morris M, Jewell E, Dechert R, et al. A Description of Intraoperative Ventilator Management in Patients with Acute Lung Injury and the Use of Lung Protective Ventilation Strategies. Anesthesiology. 2011;115(1):75-82.
[23] Katira BH, Giesinger RE, Engelberts D, Zabini D, Kornecki A, Otulakowski G, et al. Adverse heart–lung interactions in ventilator-induced lung injury. Am J Respir Crit Care Med. 2017; 196(11):1411-21.
[24] Seeley E, McAuley DF, Eisner M, Miletin M, Matthay MA, Kallet RH. Predictors of mortality in acute lung injury during the era of lung protective ventilation. Thorax. 2008; 63(11):994-8.
[25] Jaswal DS, Leung JM, Sun J, Cui X, Li Y, Kern S, et al. Tidal volume and plateau pressure use for acute lung injury from 2000 to present: a systematic literature review. Crit Care Med. 2014; 42(10):2278-89.
[26] Brown LM, Calfee CS, Matthay MA, Brower RG, Thompson BT, Checkley W, et al. A simple classification model for hospital mortality in patients with acute lung injury managed with lung protective ventilation. Crit Care Med. 2011; 39(12):2645-51.
[27] Simchen E, Sprung CL, Galai N, Zitser-Gurevich Y, Bar-Lavi Y, Levi L, et al. Survival of critically ill patients hospitalized in and out of intensive care. Crit Care Med. 2007;35(2):449-57.
[28] Hersch M, Sonnenblick M, Karlic A, Einav S, Sprung CL, Izbicki G. Mechanical ventilation of patients hospitalized in medical wards vs the intensive care unit—an observational, comparative study. J Crit Care. 2007; 22(1):13-7.
[29] Faidy A, Ouesph B, Yutuc N, Melki S, Tamonan E, Jamaly A, et al. Care of Mechanical Ventilated Patients in General Ward: Nurses Perspective. Perception. 2014; 1000(1.75):99.
[30] Guervilly C, Forel JM, Papazian L. Respiratory rate and peak inspiratory pressure, new targets from the LUNG SAFE study analysis or physiopathological artifacts? J Thorac Dis. 2017; 9(2):225-7.
[31] Walter JM, Corbridge TC, Singer BD. Invasive Mechanical Ventilation. South Med J. 2018; 111(12):746-53.
[32] Gajic O, Frutos-Vivar F, Esteban A, Hubmayr RD, Anzueto A. Ventilator settings as a risk factor for acute respiratory distress syndrome in mechanically ventilated patients. Intensive Care Med. 2005; 31(7):922-6.
[33] Shiu KK, Rosen MJ. Is there a safe plateau pressure threshold for patients with acute lung injury and acute respiratory distress syndrome? Am J Respir Crit Care Med. 2006; 173(6):686.
[34] Stewart TE, Meade MO, Cook DJ, Granton JT, Hodder RV, Lapinsky SE, et al. Evaluation of a ventilation strategy to prevent barotrauma in patients at high risk for acute respiratory distress syndrome. N Engl J Med. 1998; 338(6):355-61.
| Files | ||
| Issue | Vol 10 No 3 (2024): Summer |
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| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v10i3.15697 | |
| Keywords | ||
| Ventilator Parameters lung protective strategies Mortality Rate | ||
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