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Impact of Height Estimation on Tidal Volume Calculation for Protective Ventilation—A Prospective Observational Study

OBJECTIVES: The current standard of care to deliver invasive mechanical ventilation support is the protective ventilation approach. One pillar of this approach is the limitation of tidal volume to less than 6 mL/Kg of predicted body weight. Predicted body weight is calculated from patient’s height....

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Autores principales: Alexandre, André R., Rocha, Filipa R., Landeiro, Luís, Mota, Pedro, Jones, Joana, Gomes, José A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8162955/
https://www.ncbi.nlm.nih.gov/pubmed/34079949
http://dx.doi.org/10.1097/CCE.0000000000000422
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author Alexandre, André R.
Rocha, Filipa R.
Landeiro, Luís
Mota, Pedro
Jones, Joana
Gomes, José A.
author_facet Alexandre, André R.
Rocha, Filipa R.
Landeiro, Luís
Mota, Pedro
Jones, Joana
Gomes, José A.
author_sort Alexandre, André R.
collection PubMed
description OBJECTIVES: The current standard of care to deliver invasive mechanical ventilation support is the protective ventilation approach. One pillar of this approach is the limitation of tidal volume to less than 6 mL/Kg of predicted body weight. Predicted body weight is calculated from patient’s height. Yet, little is known about the potential impact of errors arising from visual height estimation, a common practice, to calculate tidal volumes. The aim of this study was to evaluate that impact on tidal volume calculation to use during protective ventilation. DESIGN: Prospective observational study. SETTING: An eight-bed polyvalent ICU. PATIENTS: Adult patients (≥ 18 yr). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Tidal volumes were calculated from visual height estimates made by physicians, nurses, and patients themselves and compared with tidal volumes calculated from measured heights. Comparisons were made using the paired t test. Modified Bland-Altman plots were used to assess agreement between height estimates and measurements. One-hundred patients were recruited. Regardless of the height estimator, all the mean tidal volumes would be greater than 6 mL/Kg predicted body weight (all p < 0.001). Additionally, tidal volumes would be greater than or equal to 6.5 mL/Kg predicted body weight in 18% of patients’ estimates, 25% of physicians’ estimates, and 30% of nurses’ estimates. Patients with lower stature (< 165 cm), older age, and surgical typology of admission were at increased risk of being ventilated with tidal volumes above protective threshold. CONCLUSIONS: The clinical benefit of the protective ventilation strategy can be offset by using visual height estimates to calculate tidal volumes. Additionally, this approach can be harmful and potentially increase mortality by exposing patients to tidal volumes greater than or equal to 6.5 mL/Kg predicted body weight. In the interest of patient safety, every ICU patient should have his or her height accurately measured.
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spelling pubmed-81629552021-06-01 Impact of Height Estimation on Tidal Volume Calculation for Protective Ventilation—A Prospective Observational Study Alexandre, André R. Rocha, Filipa R. Landeiro, Luís Mota, Pedro Jones, Joana Gomes, José A. Crit Care Explor Observational Study OBJECTIVES: The current standard of care to deliver invasive mechanical ventilation support is the protective ventilation approach. One pillar of this approach is the limitation of tidal volume to less than 6 mL/Kg of predicted body weight. Predicted body weight is calculated from patient’s height. Yet, little is known about the potential impact of errors arising from visual height estimation, a common practice, to calculate tidal volumes. The aim of this study was to evaluate that impact on tidal volume calculation to use during protective ventilation. DESIGN: Prospective observational study. SETTING: An eight-bed polyvalent ICU. PATIENTS: Adult patients (≥ 18 yr). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Tidal volumes were calculated from visual height estimates made by physicians, nurses, and patients themselves and compared with tidal volumes calculated from measured heights. Comparisons were made using the paired t test. Modified Bland-Altman plots were used to assess agreement between height estimates and measurements. One-hundred patients were recruited. Regardless of the height estimator, all the mean tidal volumes would be greater than 6 mL/Kg predicted body weight (all p < 0.001). Additionally, tidal volumes would be greater than or equal to 6.5 mL/Kg predicted body weight in 18% of patients’ estimates, 25% of physicians’ estimates, and 30% of nurses’ estimates. Patients with lower stature (< 165 cm), older age, and surgical typology of admission were at increased risk of being ventilated with tidal volumes above protective threshold. CONCLUSIONS: The clinical benefit of the protective ventilation strategy can be offset by using visual height estimates to calculate tidal volumes. Additionally, this approach can be harmful and potentially increase mortality by exposing patients to tidal volumes greater than or equal to 6.5 mL/Kg predicted body weight. In the interest of patient safety, every ICU patient should have his or her height accurately measured. Lippincott Williams & Wilkins 2021-05-12 /pmc/articles/PMC8162955/ /pubmed/34079949 http://dx.doi.org/10.1097/CCE.0000000000000422 Text en Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Observational Study
Alexandre, André R.
Rocha, Filipa R.
Landeiro, Luís
Mota, Pedro
Jones, Joana
Gomes, José A.
Impact of Height Estimation on Tidal Volume Calculation for Protective Ventilation—A Prospective Observational Study
title Impact of Height Estimation on Tidal Volume Calculation for Protective Ventilation—A Prospective Observational Study
title_full Impact of Height Estimation on Tidal Volume Calculation for Protective Ventilation—A Prospective Observational Study
title_fullStr Impact of Height Estimation on Tidal Volume Calculation for Protective Ventilation—A Prospective Observational Study
title_full_unstemmed Impact of Height Estimation on Tidal Volume Calculation for Protective Ventilation—A Prospective Observational Study
title_short Impact of Height Estimation on Tidal Volume Calculation for Protective Ventilation—A Prospective Observational Study
title_sort impact of height estimation on tidal volume calculation for protective ventilation—a prospective observational study
topic Observational Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8162955/
https://www.ncbi.nlm.nih.gov/pubmed/34079949
http://dx.doi.org/10.1097/CCE.0000000000000422
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