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Underuse of lung protective ventilation: analysis of potential factors to explain physician behavior
Ravi Kalhan1, Mark Mikkelsen, Pali Dedhiya
1Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Objective:
To determine the frequency of use of low-tidal-volume ventilation in appropriate patients with acute lung injury (ALI) and the factors associated with the choice of tidal volume.
Design:
Prospective observational cohort study of patients identified with ALI or acute respiratory distress syndrome from September 2000 to November 2002.
Setting:
Medical and surgical intensive care unit (ICU) at an academic tertiary-care hospital.
Measurements And Main Results:
Measurements included the proportion for whom the ventilation tidal volume (TV) was
Conclusions:
Ventilation with a low TV was used in a minority of patients with ALI, despite results published in 1998 and 2000 supporting this approach. This may be related to clinicians' underrecognition of less severe cases of ALI, their reserving of low-TV ventilation for more severe cases, or both.
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