Protective ventilation and classification in ICU patients

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

Abstract

Invasive mechanical ventilation has a strong potential to harm the lungs of critically ill patients. It was uncertain whether invasive ventilation in ICU patients without ‘acute respiratory distress syndrome’ (ARDS) should use low tidal volumes, alike in ICU patients with ARDS in whom this strategy has been shown to improve survival and shorten duration of ventilation. A multicenter randomized clinical trial tested whether use of a low tidal volume, when compared to use of an intermediate tidal volume, would shorten duration of ventilation in patients without ARDS. This trial showed no benefit of use of a low tidal volume. It should be noted, though, that patients were quickly weaned to a supported mode of ventilation, during which tidal volume size is less controllable. As a result, differences in tidal volumes in the two arms of the trial were small. Also, since intermediate tidal volumes are already relatively small, they may be sufficient protective.
Further, secondary analyses of observational studies were used to determine which factors have an association with development of pulmonary complications and outcome in ICU patients without ARDS. The maximum airway pressure was the one single potentially modifiable ventilation factor associated with outcome in these patients, alike in patients with ARDS. Finally, it was determined how ICU patients can best be classified for the risk of death. Classification using cutoffs for pulse-oximetry readings and the positive end-expiratory pressure level at 24 hours after start of ventilation has a better prognostic capacity then at start of ventilation.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
Supervisors/Advisors
  • Schultz, Marcus, Supervisor
  • Gama de Abreu, M., Supervisor, External person
  • Pelosi, P., Co-supervisor, External person
  • Serpa Neto, A., Co-supervisor
Award date19 Dec 2019
Publication statusPublished - 2019

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