Spece LJ, et al. - Low tidal volume ventilation (LTVV) reduces mortality in acute respiratory distress syndrome (ARDS) patients. In view of this, researchers sought to determine local barriers to LTVV use at a former ARDS Network hospital, presuming that this may provide new insight to improve LTVV implementation. Data demonstrated that despite significant institutional efforts to improve LTVV utilization by ARDS patients, most of them did not receive LTVV, which indicated that ARDS remains under-recognized and untreated.

Methods

• Between 2008 and 2012, a cohort of 214 randomly selected adults met the Berlin definition of ARDS at Harborview Medical Center.
• The receipt of LTVV (tidal volume of ≤6.5 mL/kg predicted body weight) within 48 h of ARDS onset was the primary outcome.
• Researchers constructed a multivariable logistic regression model to determine factors related to the outcome.

Results

• According to data, only 27% of patients received tidal volumes of ≤6.5 mL/kg PBW within 48 h of ARDS onset.
• A positive association of increasing plateau pressure (OR 1.11; 95% CI 1.03 to 1.19; p-value <0.01) with LTVV use was evident.
• Furthermore, it was also noted that increasing PaO₂:F_IO₂ ratio was negatively associated with LTVV use (OR 0.75, 95% CI 0.57 to 0.98; p-value 0.03).
• An ARDS diagnosis was reported in only 21% of the cohort.
• Findings also demonstrated that neither patient height nor gender were related to LTVV use.