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Incidence, risk factors and outcome of barotrauma in mechanically ventilated patients.

Abstract：

OBJECTIVE:To determine the incidence, risk factors, and outcome of barotrauma in a cohort of mechanically ventilated patients where limited tidal volumes and airway pressures were used. DESIGN AND SETTING:Prospective cohort of 361 intensive care units from 20 countries. PATIENTS AND PARTICIPANTS:A total of 5183 patients mechanically ventilated for more than 12 h. MEASUREMENTS AND RESULTS:Baseline demographic data, primary indication for mechanical ventilation, daily ventilator settings, multiple-organ failure over the course of mechanical ventilation and outcome were collected. Barotrauma was present in 154 patients (2.9%). The incidence varied according to the reason for mechanical ventilation: 2.9% of patients with chronic obstructive pulmonary disease; 6.3% of patients with asthma; 10.0% of patients with chronic interstitial lung disease (ILD); 6.5% of patients with acute respiratory distress syndrome (ARDS); and 4.2% of patients with pneumonia. Patients with and without barotrauma did not differ in any ventilator parameter. Logistic regression analysis identified as factors independently associated with barotrauma: asthma [RR 2.58 (1.05-6.50)], ILD [RR 4.23 (95%CI 1.78-10.03)]; ARDS as primary reason for mechanical ventilation [RR 2.70 (95%CI 1.55-4.70)]; and ARDS as a complication during the course of mechanical ventilation [RR 2.53 (95%CI 1.40-4.57)]. Case-control analysis showed increased mortality in patients with barotrauma (51.4 vs 39.2%; p=0.04) and prolonged ICU stay. CONCLUSIONS:In a cohort of patients in whom airway pressures and tidal volume are limited, barotrauma is more likely in patients ventilated due to underlying lung disease (acute or chronic). Barotrauma was also associated with a significant increase in the ICU length of stay and mortality.

journal_name

Intensive Care Med

journal_title

Intensive care medicine

authors

Anzueto A,Frutos-Vivar F,Esteban A,Alía I,Brochard L,Stewart T,Benito S,Tobin MJ,Elizalde J,Palizas F,David CM,Pimentel J,González M,Soto L,D'Empaire G,Pelosi P

doi

10.1007/s00134-004-2187-7

keywords:

subject

Has Abstract

pub_date

2004-04-01 00:00:00

pages

612-9

issue

eissn

0342-4642

issn

1432-1238

journal_volume

pub_type

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Incidence, risk factors and outcome of barotrauma in mechanically ventilated patients.