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A Comparison of Three Methods of Height Estimation and Their Impact on Low Tidal Volume Ventilation in a Mixed Ethnicity Intensive Care Unit: A Real-World Experience

Background Height measurement is crucial for calculating predicted body weight (PBW) and establishing low tidal volume ventilation (LTVV). However, standing height is usually unavailable in critically ill patients and supine height may be difficult to obtain. Objective We investigated whether there...

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Autores principales: Singh, Keevan, Gocool, Natalia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7430537/
https://www.ncbi.nlm.nih.gov/pubmed/32821572
http://dx.doi.org/10.7759/cureus.9221
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author Singh, Keevan
Gocool, Natalia
author_facet Singh, Keevan
Gocool, Natalia
author_sort Singh, Keevan
collection PubMed
description Background Height measurement is crucial for calculating predicted body weight (PBW) and establishing low tidal volume ventilation (LTVV). However, standing height is usually unavailable in critically ill patients and supine height may be difficult to obtain. Objective We investigated whether there were any significant differences in tidal volumes (VT) obtained using PBW derived from supine, forearm, and lower leg lengths in an intensive care unit (ICU) setting. Methods Supine, forearm and lower leg lengths were measured in 100 mechanically ventilated patients. Limb lengths were converted to height and PBW calculated using published formulae. The 6 mL/kg VT for the supine (sVT), forearm (fVT), and lower leg (lVT) methods were compared to each other and to visually estimated VT (estVT). Results Forearm length produced the greatest height estimate, leading to a significantly greater tidal volume fVT (437.6 ± 62.1 mL) compared with sVT (385.5 ± 63.8 mL) and lVT (369.1 ± 66.4 mL), (p < .001). There was no significant difference between lVT and sVT, (p = .169). On Bland Altman analysis, the lowest bias was found between lVT and sVT (−16.4 ± 36.0 mL, 95% limits of agreement (LOA) [−86.9, 54.1]), whereas fVT had a bias of 52.1 ± 41.5 mL, 95% LOA [−29.1, 133.4] compared to sVT. The fVT was significantly greater than sVT and lVT in all sexes and ethnic groups (p < .05). Conclusion Lower leg length may be a suitable alternative to supine height to facilitate the application of LTVV in an ICU setting.
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spelling pubmed-74305372020-08-18 A Comparison of Three Methods of Height Estimation and Their Impact on Low Tidal Volume Ventilation in a Mixed Ethnicity Intensive Care Unit: A Real-World Experience Singh, Keevan Gocool, Natalia Cureus Anesthesiology Background Height measurement is crucial for calculating predicted body weight (PBW) and establishing low tidal volume ventilation (LTVV). However, standing height is usually unavailable in critically ill patients and supine height may be difficult to obtain. Objective We investigated whether there were any significant differences in tidal volumes (VT) obtained using PBW derived from supine, forearm, and lower leg lengths in an intensive care unit (ICU) setting. Methods Supine, forearm and lower leg lengths were measured in 100 mechanically ventilated patients. Limb lengths were converted to height and PBW calculated using published formulae. The 6 mL/kg VT for the supine (sVT), forearm (fVT), and lower leg (lVT) methods were compared to each other and to visually estimated VT (estVT). Results Forearm length produced the greatest height estimate, leading to a significantly greater tidal volume fVT (437.6 ± 62.1 mL) compared with sVT (385.5 ± 63.8 mL) and lVT (369.1 ± 66.4 mL), (p < .001). There was no significant difference between lVT and sVT, (p = .169). On Bland Altman analysis, the lowest bias was found between lVT and sVT (−16.4 ± 36.0 mL, 95% limits of agreement (LOA) [−86.9, 54.1]), whereas fVT had a bias of 52.1 ± 41.5 mL, 95% LOA [−29.1, 133.4] compared to sVT. The fVT was significantly greater than sVT and lVT in all sexes and ethnic groups (p < .05). Conclusion Lower leg length may be a suitable alternative to supine height to facilitate the application of LTVV in an ICU setting. Cureus 2020-07-16 /pmc/articles/PMC7430537/ /pubmed/32821572 http://dx.doi.org/10.7759/cureus.9221 Text en Copyright © 2020, Singh et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Anesthesiology
Singh, Keevan
Gocool, Natalia
A Comparison of Three Methods of Height Estimation and Their Impact on Low Tidal Volume Ventilation in a Mixed Ethnicity Intensive Care Unit: A Real-World Experience
title A Comparison of Three Methods of Height Estimation and Their Impact on Low Tidal Volume Ventilation in a Mixed Ethnicity Intensive Care Unit: A Real-World Experience
title_full A Comparison of Three Methods of Height Estimation and Their Impact on Low Tidal Volume Ventilation in a Mixed Ethnicity Intensive Care Unit: A Real-World Experience
title_fullStr A Comparison of Three Methods of Height Estimation and Their Impact on Low Tidal Volume Ventilation in a Mixed Ethnicity Intensive Care Unit: A Real-World Experience
title_full_unstemmed A Comparison of Three Methods of Height Estimation and Their Impact on Low Tidal Volume Ventilation in a Mixed Ethnicity Intensive Care Unit: A Real-World Experience
title_short A Comparison of Three Methods of Height Estimation and Their Impact on Low Tidal Volume Ventilation in a Mixed Ethnicity Intensive Care Unit: A Real-World Experience
title_sort comparison of three methods of height estimation and their impact on low tidal volume ventilation in a mixed ethnicity intensive care unit: a real-world experience
topic Anesthesiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7430537/
https://www.ncbi.nlm.nih.gov/pubmed/32821572
http://dx.doi.org/10.7759/cureus.9221
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