Calculation of Initial Tidal Volume Settings for Acute Respiratory Distress Syndrome Patients in One Southern Ohio Hospital's Critical Care Units

摘要

Acute Respiratory Distress Syndrome (ARDS) is characterized by bilateral pulmonary infiltrates, stiff lungs, and hypoxemia, without evidence of cardiac disease. ARDS has a high mortality of around 40-50% (Slutsky, 2002). With the creation of the National Institutes of Health ARDS network in 1994, knowledge about ARDS pathophysiology and treatment has advanced tremendously (Martin, 2002). Several independent studies have shown improved prognosis of patients with Acute (Adult) Respiratory Distress Syndrome (ARDS) requiring mechanical ventilation using a tidal volume based on six milliters per kilogram (6mL/kg) of patient body weight, as opposed to the conventional tidal volume based on 12 milliters per kilogram (12mL/kg) (Amato et al., 1995: The Acute Respiratory Distress Syndrome Network, 2000). At the 98th International Conference of the American Thoracic Society a protocol based on clinical data was presented stating using lower tidal volumes is the only strategy proven to improve survival in Acute Lung Injury (ALI)/ARDS patients (Martin, 2002). The purpose of this study is to answer the following questions: (1) Do mechanically ventilated patients with ARDS in one southern Ohio hospital's critical care units receive the initial conventional tidal volumes based on the ARDS Network recommendation of 6mL/kg; and, (2) Is there a significant difference between the actual mL/kg used and the ARDS Network recommendation of 6mL/kg to calculate tidal volumes. The descriptive study used a retrospective chart review of patients diagnosed with ARDS and admifted to intensive care units between May 2002 and May 2003. The results indicated that the majority of patients did not receive the recommended tidal volume. Those patients who did receive the recommended tidal volume had a mortality rate of zero versus a mortality rate of 61% for those patients who did not receive the ARDS Network recommended tidal volume based on 6mL/kg.