title: Mechanical ventilation with lower tidal volumes does not influence the prescription of opioids or sedatives.
abstract: BACKGROUND
  We compared the effects of mechanical ventilation with a lower tidal volume (V(T)) strategy versus those of greater V(T) in patients with or without acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) on the use of opioids and sedatives.
  
  
  METHODS
  This is a secondary analysis of a previously conducted before/after intervention study, which consisting of feedback and education on lung protective mechanical ventilation using lower V(T). We evaluated the effects of this intervention on medication prescriptions from days 0 to 28 after admission to our multidisciplinary intensive care unit.
  
  
  RESULTS
  Medication prescriptions in 23 patients before and 38 patients after intervention were studied. Of these patients, 10 (44%) and 15 (40%) suffered from ALI/ARDS. The V(T) of ALI/ARDS patients declined from 9.7 ml/kg predicted body weight (PBW) before to 7.8 ml/kg PBW after the intervention (P = 0.007). For patients who did not have ALI/ARDS there was a trend toward a decline from 10.2 ml/kg PBW to 8.6 ml/kg PBW (P = 0.073). Arterial carbon dioxide tension was significantly greater after the intervention in ALI/ARDS patients. Neither the proportion of patients receiving opioids or sedatives, or prescriptions at individual time points differed between pre-intervention and post-intervention. Also, there were no statistically significant differences in doses of sedatives and opioids. Findings were no different between non-ALI/ARDS patients and ALI/ARDS patients.
  
  
  CONCLUSIONS
  Concerns regarding sedation requirements with use of lower V(T) are unfounded and should not preclude its use in patients with ALI/ARDS.
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. e.k.wolthuis@amc.uva.nl
authors.forename: Esther K
authors.initials: EK
authors.lastname: Wolthuis
authors.forename: Denise P
authors.initials: DP
authors.lastname: Veelo
authors.forename: Goda
authors.initials: G
authors.lastname: Choi
authors.forename: Rogier M
authors.initials: RM
authors.lastname: Determann
authors.forename: Johanna C
authors.initials: JC
authors.lastname: Korevaar
authors.forename: Peter E
authors.initials: PE
authors.lastname: Spronk
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kuiper
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Schultz
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy*; D013990:Tidal Volume
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives