title: Intraoperative adherence to a low tidal volume ventilation strategy in critically ill patients with preexisting acute lung injury.
abstract: OBJECTIVE
  Low tidal volume (LTV) ventilation reduces mortality in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). This study investigates adherence of intraoperative LTV and whether patient outcomes were different with or without continued intraoperative LTV ventilation in patients with previously established ALI or ARDS.
  
  
  METHODS
  A retrospective analysis was performed of adults with ALI/ARDS over a 2-year period who underwent surgery between 24 hours and 14 days after the diagnosis of ALI/ARDS. The main outcome was intraoperative LTV use. Secondary outcomes included perioperative respiratory and clinical outcomes.
  
  
  RESULTS
  Of the 249 patients who underwent surgery between 24 hours and 14 days after ALI/ARDS diagnosis, 101 (41%) received preoperative LTV ventilation. Fifty-four (53%) received intraoperative LTV ventilation, whereas 47 (47%) did not. Use of preoperative LTV ventilation was associated with use of intraoperative LTV ventilation (P < .01). No differences in respiratory or clinical outcomes between patients with or without intraoperative LTV ventilation were observed.
  
  
  CONCLUSIONS
  Adherence to intraoperative LTV in surgical patients was low. Adherence of LTV intraoperatively was not associated with improved oxygenation, reductions in hospital length of stay, or in-hospital mortality. The importance of adhering to an intraoperative LTV strategy remains unclear.
authors.affiliation: Department of Anesthesiology, University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Onuma
authors.initials: O
authors.lastname: Chaiwat
authors.forename: Monica S
authors.initials: MS
authors.lastname: Vavilala
authors.forename: Shaji
authors.initials: S
authors.lastname: Philip
authors.forename: Amin
authors.initials: A
authors.lastname: Malakouti
authors.forename: Margaret J
authors.initials: MJ
authors.lastname: Neff
authors.forename: Steven
authors.initials: S
authors.lastname: Deem
authors.forename: Miriam M
authors.initials: MM
authors.lastname: Treggiari
authors.forename: Jin
authors.initials: J
authors.lastname: Wang
authors.forename: John D
authors.initials: JD
authors.lastname: Lang
mesh_terms: D018806:APACHE; D055371:Acute Lung Injury / Q000517:prevention & control*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D005260:Female; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007432:Intraoperative Period; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D013990:Tidal Volume; D055815:Young Adult