Tidal Volume

14,000,000 Leading Edge Experts on the ideXlab platform

Scan Science and Technology

Contact Leading Edge Experts & Companies

Scan Science and Technology

Contact Leading Edge Experts & Companies

The Experts below are selected from a list of 288 Experts worldwide ranked by ideXlab platform

Chad Oughton - One of the best experts on this subject based on the ideXlab platform.

  • effect of intraoperative low Tidal Volume vs conventional Tidal Volume on postoperative pulmonary complications in patients undergoing major surgery a randomized clinical trial
    JAMA, 2020
    Co-Authors: Dharshi Karalapillai, Laurence Weinberg, Philip J Peyton, Louise Ellard, Raymond Hu, Brett Pearce, David A Story, Mark Odonnell, Patrick Hamilton, Chad Oughton
    Abstract:

    Importance In patients who undergo mechanical ventilation during surgery, the ideal Tidal Volume is unclear. Objective To determine whether low-Tidal-Volume ventilation compared with conventional ventilation during major surgery decreases postoperative pulmonary complications. Design, Setting, and Participants Single-center, assessor-blinded, randomized clinical trial of 1236 patients older than 40 years undergoing major noncardiothoracic, nonintracranial surgery under general anesthesia lasting more than 2 hours in a tertiary hospital in Melbourne, Australia, from February 2015 to February 2019. The last date of follow-up was February 17, 2019. Interventions Patients were randomized to receive a Tidal Volume of 6 mL/kg predicted body weight (n = 614; low Tidal Volume group) or a Tidal Volume of 10 mL/kg predicted body weight (n = 592; conventional Tidal Volume group). All patients received positive end-expiratory pressure (PEEP) at 5 cm H2O. Main Outcomes and Measures The primary outcome was a composite of postoperative pulmonary complications within the first 7 postoperative days, including pneumonia, bronchospasm, atelectasis, pulmonary congestion, respiratory failure, pleural effusion, pneumothorax, or unplanned requirement for postoperative invasive or noninvasive ventilation. Secondary outcomes were postoperative pulmonary complications including development of pulmonary embolism, acute respiratory distress syndrome, systemic inflammatory response syndrome, sepsis, acute kidney injury, wound infection (superficial and deep), rate of intraoperative need for vasopressor, incidence of unplanned intensive care unit admission, rate of need for rapid response team call, intensive care unit length of stay, hospital length of stay, and in-hospital mortality. Results Among 1236 patients who were randomized, 1206 (98.9%) completed the trial (mean age, 63.5 years; 494 [40.9%] women; 681 [56.4%] undergoing abdominal surgery). The primary outcome occurred in 231 of 608 patients (38%) in the low Tidal Volume group compared with 232 of 590 patients (39%) in the conventional Tidal Volume group (difference, −1.3% [95% CI, −6.8% to 4.2%]; risk ratio, 0.97 [95% CI, 0.84-1.11];P = .64). There were no significant differences in any of the secondary outcomes. Conclusions and Relevance Among adult patients undergoing major surgery, intraoperative ventilation with low Tidal Volume compared with conventional Tidal Volume, with PEEP applied equally between groups, did not significantly reduce pulmonary complications within the first 7 postoperative days. Trial Registration ANZCTR Identifier:ACTRN12614000790640

  • low Tidal Volume ventilation during anaesthesia for major surgery protocol and statistical analysis plan
    Critical Care and Resuscitation, 2019
    Co-Authors: Dharshi Karalapillai, Laurence Weinberg, Philip J Peyton, Louise Ellard, Raymond Hu, Brett Pearce, David A Story, Mark Odonnell, Patrick Hamilton, Chad Oughton
    Abstract:

    BACKGROUND: Mechanical ventilation is mandatory in patients undergoing general anaesthesia for major surgery. Tidal Volumes higher than 10 mL/kg of predicted body weight have been advocated for intraoperative ventilation, but recent evidence suggests that low Tidal Volumes may benefit surgical patients. To date, the impact of low Tidal Volume compared with conventional Tidal Volume during surgery has only been assessed in clinical trials that also combine different levels of positive end-expiratory pressure (PEEP) in each arm. We aimed to assess the impact of low Tidal Volume compared with conventional Tidal Volume during general anaesthesia for surgery on the incidence of postoperative respiratory complications in adult patients receiving moderate levels of PEEP. STUDY DESIGN AND METHODS: Single-centre, two-arm, randomised clinical trial. In total, 1240 adult patients older than 40 years scheduled for at least 2 hours of surgery under general anaesthesia and routinely monitored with an arterial line were included. Patients were ventilated intraoperatively with a moderate level of PEEP (5 cmH2O) and randomly assigned to Tidal Volume of 6 mL/kg predicted body weight (low Tidal Volume) or 10 mL/kg predicted body weight (conventional Tidal Volume in Australia). MAIN OUTCOME MEASURE: The primary outcome is the occurrence of postoperative respiratory complications, recorded as a composite endpoint of adverse respiratory events during the first 7 postoperative days. RESULTS AND CONCLUSIONS: This is the first well powered study comparing the effect of low Tidal Volume ventilation versus high Tidal Volume ventilation during surgery on the incidence of postoperative respiratory complications in adult patients receiving moderate levels of PEEP. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12614000790640).

Richard G Wunderink - One of the best experts on this subject based on the ideXlab platform.

S. A. Loer - One of the best experts on this subject based on the ideXlab platform.

  • Variations in respiratory rate do not reflect changes in Tidal Volume or minute ventilation after major abdominal surgery
    Journal of Clinical Monitoring and Computing, 2020
    Co-Authors: O. F. C. Van Den Bosch, R. Alvarez-jimenez, M. M. H. Stam, F. C. Den Boer, S. A. Loer
    Abstract:

    Monitoring of postoperative pulmonary function usually includes respiratory rate and oxygen saturation measurements. We hypothesized that changes in postoperative respiratory rate do not correlate with changes in Tidal Volume or minute ventilation. In addition, we hypothesized that variability of minute ventilation and Tidal Volume is larger than variability of respiratory rate. Respiratory rate and changes in Tidal Volume and in minute ventilation were continuously measured in 27 patients during 24 h following elective abdominal surgery, using an impedance-based non-invasive respiratory Volume monitor (ExSpiron, Respiratory Motion, Waltham, MA, US). Coefficients of variation were used as a measure for variability of respiratory rate, Tidal Volume and minute ventilation. Data of 38,149 measurements were analyzed. We found no correlation between respiratory rate and Tidal Volume or minute ventilation (r^2 = 0.02 and 0.01). Mean respiratory rate increased within the first 24 h after abdominal surgery from 13.9 ± 2.5 to 16.2 ± 2.4 breaths/min ( p  = 0.008), while Tidal Volume and minute ventilation remained unchanged ( p  = 0.90 and p  = 0.18). Of interest, variability of respiratory rate (0.21 ± 0.06) was significantly smaller than variability of Tidal Volume (0.37 ± 0.12, p  

David W Baker - One of the best experts on this subject based on the ideXlab platform.

Dharshi Karalapillai - One of the best experts on this subject based on the ideXlab platform.

  • effect of intraoperative low Tidal Volume vs conventional Tidal Volume on postoperative pulmonary complications in patients undergoing major surgery a randomized clinical trial
    JAMA, 2020
    Co-Authors: Dharshi Karalapillai, Laurence Weinberg, Philip J Peyton, Louise Ellard, Raymond Hu, Brett Pearce, David A Story, Mark Odonnell, Patrick Hamilton, Chad Oughton
    Abstract:

    Importance In patients who undergo mechanical ventilation during surgery, the ideal Tidal Volume is unclear. Objective To determine whether low-Tidal-Volume ventilation compared with conventional ventilation during major surgery decreases postoperative pulmonary complications. Design, Setting, and Participants Single-center, assessor-blinded, randomized clinical trial of 1236 patients older than 40 years undergoing major noncardiothoracic, nonintracranial surgery under general anesthesia lasting more than 2 hours in a tertiary hospital in Melbourne, Australia, from February 2015 to February 2019. The last date of follow-up was February 17, 2019. Interventions Patients were randomized to receive a Tidal Volume of 6 mL/kg predicted body weight (n = 614; low Tidal Volume group) or a Tidal Volume of 10 mL/kg predicted body weight (n = 592; conventional Tidal Volume group). All patients received positive end-expiratory pressure (PEEP) at 5 cm H2O. Main Outcomes and Measures The primary outcome was a composite of postoperative pulmonary complications within the first 7 postoperative days, including pneumonia, bronchospasm, atelectasis, pulmonary congestion, respiratory failure, pleural effusion, pneumothorax, or unplanned requirement for postoperative invasive or noninvasive ventilation. Secondary outcomes were postoperative pulmonary complications including development of pulmonary embolism, acute respiratory distress syndrome, systemic inflammatory response syndrome, sepsis, acute kidney injury, wound infection (superficial and deep), rate of intraoperative need for vasopressor, incidence of unplanned intensive care unit admission, rate of need for rapid response team call, intensive care unit length of stay, hospital length of stay, and in-hospital mortality. Results Among 1236 patients who were randomized, 1206 (98.9%) completed the trial (mean age, 63.5 years; 494 [40.9%] women; 681 [56.4%] undergoing abdominal surgery). The primary outcome occurred in 231 of 608 patients (38%) in the low Tidal Volume group compared with 232 of 590 patients (39%) in the conventional Tidal Volume group (difference, −1.3% [95% CI, −6.8% to 4.2%]; risk ratio, 0.97 [95% CI, 0.84-1.11];P = .64). There were no significant differences in any of the secondary outcomes. Conclusions and Relevance Among adult patients undergoing major surgery, intraoperative ventilation with low Tidal Volume compared with conventional Tidal Volume, with PEEP applied equally between groups, did not significantly reduce pulmonary complications within the first 7 postoperative days. Trial Registration ANZCTR Identifier:ACTRN12614000790640

  • Effect of Intraoperative Low Tidal Volume vs Conventional Tidal Volume on Postoperative Pulmonary Complications in Patients Undergoing Major Surgery: A Randomized Clinical Trial.
    JAMA, 2020
    Co-Authors: Dharshi Karalapillai, Laurence Weinberg, Philip J Peyton, Louise Ellard, Raymond Hu, Brett Pearce, David Story, Mark O'donnell, Patrick Hamilton
    Abstract:

    In patients who undergo mechanical ventilation during surgery, the ideal Tidal Volume is unclear. To determine whether low-Tidal-Volume ventilation compared with conventional ventilation during major surgery decreases postoperative pulmonary complications. Single-center, assessor-blinded, randomized clinical trial of 1236 patients older than 40 years undergoing major noncardiothoracic, nonintracranial surgery under general anesthesia lasting more than 2 hours in a tertiary hospital in Melbourne, Australia, from February 2015 to February 2019. The last date of follow-up was February 17, 2019. Patients were randomized to receive a Tidal Volume of 6 mL/kg predicted body weight (n = 614; low Tidal Volume group) or a Tidal Volume of 10 mL/kg predicted body weight (n = 592; conventional Tidal Volume group). All patients received positive end-expiratory pressure (PEEP) at 5 cm H2O. The primary outcome was a composite of postoperative pulmonary complications within the first 7 postoperative days, including pneumonia, bronchospasm, atelectasis, pulmonary congestion, respiratory failure, pleural effusion, pneumothorax, or unplanned requirement for postoperative invasive or noninvasive ventilation. Secondary outcomes were postoperative pulmonary complications including development of pulmonary embolism, acute respiratory distress syndrome, systemic inflammatory response syndrome, sepsis, acute kidney injury, wound infection (superficial and deep), rate of intraoperative need for vasopressor, incidence of unplanned intensive care unit admission, rate of need for rapid response team call, intensive care unit length of stay, hospital length of stay, and in-hospital mortality. Among 1236 patients who were randomized, 1206 (98.9%) completed the trial (mean age, 63.5 years; 494 [40.9%] women; 681 [56.4%] undergoing abdominal surgery). The primary outcome occurred in 231 of 608 patients (38%) in the low Tidal Volume group compared with 232 of 590 patients (39%) in the conventional Tidal Volume group (difference, -1.3% [95% CI, -6.8% to 4.2%]; risk ratio, 0.97 [95% CI, 0.84-1.11]; P = .64). There were no significant differences in any of the secondary outcomes. Among adult patients undergoing major surgery, intraoperative ventilation with low Tidal Volume compared with conventional Tidal Volume, with PEEP applied equally between groups, did not significantly reduce pulmonary complications within the first 7 postoperative days. ANZCTR Identifier: ACTRN12614000790640.

  • low Tidal Volume ventilation during anaesthesia for major surgery protocol and statistical analysis plan
    Critical Care and Resuscitation, 2019
    Co-Authors: Dharshi Karalapillai, Laurence Weinberg, Philip J Peyton, Louise Ellard, Raymond Hu, Brett Pearce, David A Story, Mark Odonnell, Patrick Hamilton, Chad Oughton
    Abstract:

    BACKGROUND: Mechanical ventilation is mandatory in patients undergoing general anaesthesia for major surgery. Tidal Volumes higher than 10 mL/kg of predicted body weight have been advocated for intraoperative ventilation, but recent evidence suggests that low Tidal Volumes may benefit surgical patients. To date, the impact of low Tidal Volume compared with conventional Tidal Volume during surgery has only been assessed in clinical trials that also combine different levels of positive end-expiratory pressure (PEEP) in each arm. We aimed to assess the impact of low Tidal Volume compared with conventional Tidal Volume during general anaesthesia for surgery on the incidence of postoperative respiratory complications in adult patients receiving moderate levels of PEEP. STUDY DESIGN AND METHODS: Single-centre, two-arm, randomised clinical trial. In total, 1240 adult patients older than 40 years scheduled for at least 2 hours of surgery under general anaesthesia and routinely monitored with an arterial line were included. Patients were ventilated intraoperatively with a moderate level of PEEP (5 cmH2O) and randomly assigned to Tidal Volume of 6 mL/kg predicted body weight (low Tidal Volume) or 10 mL/kg predicted body weight (conventional Tidal Volume in Australia). MAIN OUTCOME MEASURE: The primary outcome is the occurrence of postoperative respiratory complications, recorded as a composite endpoint of adverse respiratory events during the first 7 postoperative days. RESULTS AND CONCLUSIONS: This is the first well powered study comparing the effect of low Tidal Volume ventilation versus high Tidal Volume ventilation during surgery on the incidence of postoperative respiratory complications in adult patients receiving moderate levels of PEEP. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12614000790640).