title: Lung protective mechanical ventilation strategies in cardiothoracic critical care: a retrospective study.
abstract: A body of evidence supports the use of low tidal volumes in ventilated patients without lung pathology to slow progress to acute respiratory distress syndrome (ARDS) due to ventilator associated lung injury. We undertook a retrospective chart review and tested the hypothesis that tidal volume is a predictor of mortality in cardiothoracic (medical and surgical) critical care patients receiving invasive mechanical ventilation. Independent predictors of mortality in our study included: type of surgery, albumin, H+, bilirubin, and fluid balance. In particular, it is important to note that cardiac, thoracic, and transplant surgical patients were associated with lower mortality. However, our study did not sample equally from The Berlin Definition of ARDS severity categories (mild, moderate, and severe hypoxemia). Although our study was not adequately powered to detect a difference in mortality between these groups, it will inform the development of a large prospective cohort study exploring the role of low tidal volume ventilation in cardiothoracic critically ill patients.
authors.affiliation: Department of Intensive Care Medicine, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust; Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham; Department of Anesthesia and Intensive Care Medicine, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Zochios
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge; Department of Medicine, Colchester Hospital University NHS Foundation Trust, Colchester General Hospital, Colchester.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hague
authors.affiliation: Research and Development Department, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Giraud
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge.
authors.forename: Nicola
authors.initials: N
authors.lastname: Jones
keywords: acute respiratory distress syndrome; cardiothoracic critical care; invasive mechanical ventilation; lung protective ventilation