Lung protective mechanical ventilation strategies in cardiothoracic critical care: a retrospective study

Abstract

A body of evidence supports the use of low tidal volumes in ventilated patients without lung pathology to slow progress to acute respiratory distress syndrome (ARDS) due to ventilator associated lung injury. We undertook a retrospective chart review and tested the hypothesis that tidal volume is a predictor of mortality in cardiothoracic (medical and surgical) critical care patients receiving invasive mechanical ventilation. Independent predictors of mortality in our study included: type of surgery, albumin, H⁺, bilirubin, and fluid balance. In particular, it is important to note that cardiac, thoracic, and transplant surgical patients were associated with lower mortality. However, our study did not sample equally from The Berlin Definition of ARDS severity categories (mild, moderate, and severe hypoxemia). Although our study was not adequately powered to detect a difference in mortality between these groups, it will inform the development of a large prospective cohort study exploring the role of low tidal volume ventilation in cardiothoracic critically ill patients.

Keywords:

• lung protective ventilation
• cardiothoracic critical care
• acute respiratory distress syndrome
• invasive mechanical ventilation

Acknowledgments

An abstract of this paper was presented as a poster at the Critical Care Canada Forum on 2nd November 2016 at Sheraton Centre Toronto Hotel, Toronto, ON, Canada.

Disclosure

The authors report no conflicts of interest in this work.