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Portable chest radiographs identify mechanical ventilator-associated hyperinflation
E W Ely1, D L Bowton, J C Reed
1Department of Internal Medicine, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, N.C., USA.
Chest
|August 1, 1994
Summary
Portable chest radiographs reveal hyperinflation in mechanically ventilated patients, linked to higher tidal volumes and lower body weight. This finding may help predict barotrauma development.
Area of Science:
- Critical Care Medicine
- Radiology
- Pulmonary Medicine
Background:
- Portable chest radiographs (CRs) are standard for mechanically ventilated patients.
- The correlation between CR findings and ventilator parameters remains poorly understood.
Purpose of the Study:
- To investigate the relationship between radiographically apparent hyperinflation on CR and various ventilator parameters.
- To determine if hyperinflation correlates with tidal volume (VT), body weight (BW), VT/kg, peak airway pressure (PAP), positive end-expiratory pressure (PEEP), or pressure support (PS).
Main Methods:
- Prospective study comparing CR findings with ventilator parameters in 62 mechanically ventilated patients.
- CRs were classified as hyperinflated (H+) or nonhyperinflated (H-) using subjective and objective criteria.
- Ventilator parameters were recorded at the time of CR and analyzed.
Main Results:
- Subjectively hyperinflated CRs (H+) were associated with higher VT/kg, lower BW, higher PEEP, and higher PAP compared to nonhyperinflated CRs (H-).
- Objectively, H+ CRs showed significantly higher VT/kg and lower BW.
- Multivariate analysis indicated higher VT, PEEP, and older age predicted hyperinflation.
- Four of 25 (16%) patients with objectively H+ CRs developed barotrauma, versus none with H- CRs (p=0.037).
Conclusions:
- Hyperinflation on portable CR in mechanically ventilated patients is associated with higher VT, VT/kg, and lower BW.
- Radiographic hyperinflation may serve as a predictor for subsequent barotrauma development.