Lung-protective ventilation in intensive care unit and operation room: Tidal volume size, level of positive end-expiratory pressure and driving pressure

Research output: PhD ThesisPhD-Thesis - Research and graduation internal

Abstract

Several investigations have shown independent associations between three ventilator settings – tidal volume size, positive end–expiratory pressure (PEEP) and driving pressure – and outcomes in patients with the acute respiratory distress syndrome (ARDS). There is an increasing notion that similar associations may exist between these ventilation parameters and outcomes in intensive care unit (ICU) patients without ARDS. Even in surgery patients, who usually receive mechanical ventilation for shorter periods of time than ICU patients, outcomes could depend on these three settings.
The main aim of this thesis was to investigate associations between tidal volume size, PEEP and driving pressures, and outcomes in ICU patients without ARDS, patients receiving intraoperative ventilation, and patients receiving extracorporeal support as a rescue therapy for ARDS. We hypothesized that tidal volumes, PEEP and driving pressure are independently associated with outcomes in these groups of patients.
The main findings are that three potentially modifiable ventilator settings – tidal volume, PEEP and driving pressure – have independent associations with diverse outcomes in ICU patients without ARDS, in surgery patients receiving intraoperative ventilation, and in ARDS patients under extracorporeal support. All these findings strongly support the idea that strategies aiming at optimization of these three settings could improve outcomes of patients receiving mechanical ventilatory support.
We further suggest that one way to monitor the risk of damage caused by mechanical ventilation is to monitor the amount of energy transferred during mechanical ventilation. Finally, driving pressure itself is an important driver of the energy delivered by the ventilator to lung in each breath.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • Other
Supervisors/Advisors
  • Schultz, Marcus J., Supervisor
  • Pelosi, P., Supervisor, External person
  • Gama de Abreu, M., Co-supervisor, External person
  • Hemmes, S.N.T., Co-supervisor, External person
Award date15 Sep 2017
Publication statusPublished - 2017

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