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The Effects of Initial Tidal Volumes on Outcomes in Patients Without ARDS FREE TO VIEW

Brett Lindgren, DO; Uyen Hoang, DO; Mohamed Abou El Fadl, MD
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Mercy Catholic Medical Center, Philadelphia, PA

Chest. 2015;148(4_MeetingAbstracts):181A. doi:10.1378/chest.2250545
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: The purpose of this study is to compare mortality and clinical outcomes for patients without ARDS based on initial tidal volumes in a community-hospital setting.

METHODS: Retrospective chart review of patients placed on mechanical ventilation admitted to a community teaching hospital between May 2012 and August 2014. Patients with the diagnosis of ARDS, chronic tracheostomy, initial tidal volume < 6 cc/kg ideal body weight (IBW), and/or immediately postoperative were excluded from the study. Patients were divided into three groups according to initial tidal volume setting based on ideal body weight. Patients ventilated with 6-8 cc/kg IBW were included in Group I, 8-10 cc/kg IBW in Group II and > 10 cc/kg IBW in Group III.

RESULTS: 334 patients were included: 183 patients in Group I, 129 in Group II and 22 patients in Group III. Mean±SD age was similar among all groups (65±15 vs. 66±15 vs 69±13, p = NS). The majority of patients in Group I were male (124 vs. 59) and in Group II and III were female (27 vs. 102 and 2 vs. 20, respectively). Severity of illness did not differ between all groups (APACHE II (30.77±8.23 vs. 30.71±7.84 vs. 32.63±7.97, p=NS) and SOFA (8.78±3.57 vs. 8.47±3.22 vs. 8.31±3.26, p=NS)). Peak and plateau pressures were significantly lower in Group I compared to Group II (28.04 ± 8.24 vs 30.24 ± 8.41, P = 0.02 and 19.55±6.49 vs 21.49±6.66, P=0.01, Groups I and II respectively). Survival to hospital discharge was higher in Group II (76.7%) compared with Groups I (73.2%) and III (63.6%), however did not reach statistical significance due to sample size. There was no significant difference in ventilator days, ICU length of stay, or hospital length of stay.

CONCLUSIONS: Our study showed no significant difference in survival to hospital discharge, ventilator days, ICU length of stay, or hospital length of stay when comparing three groups based on initial tidal volumes. There was evidence of a trend to improved survival in patients placed on initial tidal volumes of 8-10 cc/kg IBW. Further studies with larger sample sizes are needed to detect a significant difference in clinical outcomes.

CLINICAL IMPLICATIONS: Our study demonstrates a trend to improved survival in patients placed on initial tidal volumes of 8-10 cc/kg IBW. This can serve as a hypothesis to create further studies with larger sample sizes in order to evaluate clinical outcomes based tidal volumes.

DISCLOSURE: The following authors have nothing to disclose: Brett Lindgren, Uyen Hoang, Mohamed Abou El Fadl

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