Evaluating the generalisability of formulas used to set tidal volumes in mechanically ventilated patients: an observational, multicohort, retrospective study
Abstract
BACKGROUND: Lung-protective mechanical ventilation with low tidal volume (VT) decreased mortality in the ARMA trial. VT in that trial was adjusted to predicted bodyweight (PBW) as a proxy for preinjury lung volumes, an approach that is now commonly used to set target VT in patients who are mechanically ventilated. In other clinical contexts, PBW is not used to estimate lung volumes and spirometric reference equations are used instead. We aimed to compare predicted forced vital capacity (PFVC), calculated using the Global Lung Initiative 2012 spirometric reference equations, with PBW as a proxy for preinjury lung volume.
METHODS: In this observational, multicohort, retrospective study we compared ARMA PBW with PFVC estimated with the Global Lung Initiative 2012 reference equations for two cohorts: Medical Information Mart for Intensive Care-IV (MIMIC-IV), a cohort of patients from a single academic medical centre in Boston, MA, USA, and electronic Intensive Care Unit Collaborative Research Database (eICU-CRD), a cohort of patients from 208 hospitals in the USA. Patients who had lung-protective ventilation, hypoxaemia, and height in the range 150-210 cm were included. The data were collected from publicly available, deidentified datasets. We then studied the association between normalised VT (VT per PBW or VT per PFVC) and the ratio of lung volume estimates (PBW:PFVC) and mortality, driving pressure, and normalised elastance in patients receiving lung-protective ventilation…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 9,152 participants or records.
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