Low-tidal volume mechanical ventilation in patients with acute respiratory distress syndrome caused by pandemic influenza A/H1N1 infection

Dong Kyu Oh, Myung Goo Lee, Eun Young Choi, Jaemin Lim, Hyun Kyung Lee, Seok Chan Kim, Chae Man Lim, Younsuck Koh, Sang Bum Hong, Gee Young Suh, Kyeongman Jeon, Shin Ok Koh, Moo Suk Park, Won Il Choi, Sung Han Kim, Jong Joon Ahn, Jin Won Huh, Sang Ho Choi, Won Young Kim, Sung Cheol YunMin ju Kim, Sang Hyun Kwak, Young Joo Lee, Heung Bum Lee, Jae Yeol Kim, Jae Hwa Cho, Hye Sook Choi, Yong Bum Park, Ho Cheol Kim, Yeon Sook Kim, Chang Young Lim, Ki Uk Kim, Yun Seong Kim, Hye Ryoun Kim, Yon Ju Ryu, Min Soo Han, Young Gwan Ko, Sun Jong Kim, Gyu Rak Chon, Kwan Ho Lee

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

Purpose: Low-tidal volume (TV) mechanical ventilation is an important manipulation in managing patients with acute respiratory distress syndrome (ARDS). However, there is no definite evidence to support the use of this intervention in patients with viral etiologies. Materials and methods: A retrospective observational study of 104 patients with ARDS caused by pandemic influenza A/H1N1 infection admitted to 28 intensive care units (ICUs) in Korea was performed. Patients were categorized into 3 groups according to the TV they received: TV less than or equal to 7 mL/kg, TV greater than 7 mL/kg but less than or equal to 9 mL/kg, or TV greater than 9 mL/kg. Results: The mean age was 55.1 years, and 55.8% were male (n = 58). Patients with TV greater than 9 mL/kg showed higher 28-day ICU mortality than the 2 other groups (vs TV < 7 mL/kg, P = .007 and vs 7 mL/kg < TV ≤ 9 mL/kg, P = .004, respectively). Patients with TV less than or equal to 7 mL/kg required ventilators, ICU admissions, and hospitalizations for fewer days than those with TV greater than 7 mL/kg (11.4 vs 6.1 days for 28-day ventilator-free days, 9.7 vs 4.9 days for 28-day ICU-free days, and 5.2 vs 2.4 days for 28-day hospital-free days, respectively). Tidal volume greater than 9 mL/kg (hazard rate, 2.459; P = .003) and Sequential Organ Failure Assessment score (hazard rate, 1.158; P = .014) were significant predictors of 28-day ICU mortality. Conclusions: Low-TV mechanical ventilation still benefits patients with ARDS caused by viral pneumonia.

Original languageEnglish
Pages (from-to)358-364
Number of pages7
JournalJournal of Critical Care
Volume28
Issue number4
DOIs
StatePublished - Aug 2013

Keywords

  • Acute respiratory distress syndrome (ARDS)
  • Influenza A virus
  • Mechanical ventilators
  • Tidal volume

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