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[Noyac]

I searched but couldn't fine the thread that was asking what everyone did with regards to Tidal Volumes. But the current issue of Anesthesiology has a decent article on TV's. It doesn't come to any conclusions or recommendations but it does get one thinking about the current thinking on TV's.

http://www.anesthesiology.org/pt/re...kJyJnr9sTJy0pR!-1547828331!-949856145!8091!-1

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[militarymd]

NNTT is too high...I suspect...for any meaningful studies to be ever done.

Our time in the OR is so short in the grand scheme of things....we can be (and frequently are) complete blithering idiots in terms of care of the significantly ill patients that it doesn't matter what we do...

it won't affect outcome.

 

[Noyac]

NNTT?

The article does briefly address the issue of the short time in the OR. But most of the OR cases they address are the CABG's, thoracotomies, and esophagectomies. They measured the IL's (interleukins). No concensus, however.

 

[militarymd]

NNTT?

The article does briefly address the issue of the short time in the OR. But most of the OR cases they address are the CABG's, thoracotomies, and esophagectomies. They measured the IL's (interleukins). No concensus, however.

Number Needed To Treat

 

[epidural man]

Noyac,

Thank you for that reference to a great article. It seems there were many studies in the chart that would indicate that larger volumes were okay - or at least not different from smaller volumes.

I have always pondered this issue that our ICU trained anesthesiologists always address and stress in the OR - that is - that we should use 6-8cc/kg in all our patients regardless of their lung status.

This has never made much sense to me. When I ask my patients to take a deep breath, many of them take a tidal volume of 2000+ ml, and I am suppose to worry about ventilating him at 750cc (as opposed to 450-500)? It always perplexed me that people would try to use the ARDS net trial to make statements about my strategy in the OR, since we know that while ventilating someone with ARDS, only about a 3rd of the lung is actually seeing a tidal volume - so of course a lower volume makes sense, but in a healthy lung? - especially when a larger tidal volume still has peak pressures less than 20?

Anyway, thanks again.

 

[urgewrx]

since we know that while ventilating someone with ARDS, only about a 3rd of the lung is actually seeing a tidal volume - so of course a lower volume makes sense, but in a healthy lung? - especially when a larger tidal volume still has peak pressures less than 20?

Hum? Interesting? "so of course a lower volume makes sense". Is that right?
Makes so much sense that the entire medical profession around the world was doing the opposite to it for many, many, years. Killing thousands of patients with the wrong therapy along the way. Until when? 5 to 10 yrs ago when they published a famous paper that everyone has heard about.

You suffer from outcome bias.


BTW, I use low tidal volumes. My reason is that we usually take small tidal volumes and have auto peep around 6-8 from the vocal cords. I try to imitate the same physiology in the or. I know it will not be the same ever with positive pressure ventilation, but that's the best I can do. Every now and then I give a big TV to "open" the lung.

 

[VolatileAgent]

When I ask my patients to take a deep breath, many of them take a tidal volume of 2000+ ml, and I am suppose to worry about ventilating him at 750cc (as opposed to 450-500)?

with all due respect, you are confusing negative pressure breathing with positive pressure ventilation. very different physiologically. things change when you paralyze someone and jam a tube down their throat.

 

[toughlife]

Hum? Interesting? "so of course a lower volume makes sense". Is that right?
Makes so much sense that the entire medical profession around the world was doing the opposite to it for many, many, years. Killing thousands of patients with the wrong therapy along the way. Until when? 5 to 10 yrs ago when they published a famous paper that everyone has heard about.

You suffer from outcome bias.


BTW, I use low tidal volumes. My reason is that we usually take small tidal volumes and have auto peep around 6-8 from the vocal cords. I try to imitate the same physiology in the or. I know it will not be the same ever with positive pressure ventilation, but that's the best I can do. Every now and then I give a big TV to "open" the lung.

That's what the article says. Small tidal volumes with some peep appears to be better than big Tv with no peep.

 

[epidural man]

Here is a new article on the subject.

Anesthesiology 2008; 108:46–54
Mechanical Ventilation with Lower Tidal Volumes and
Positive End-expiratory Pressure Prevents Pulmonary
Inflammation in Patients without Preexisting Lung Injury

I searched but couldn't fine the thread that was asking what everyone did with regards to Tidal Volumes. But the current issue of Anesthesiology has a decent article on TV's. It doesn't come to any conclusions or recommendations but it does get one thinking about the current thinking on TV's.

http://www.anesthesiology.org/pt/re/anes/pdfhandler.00000542-200706000-00024.pdf;jsessionid=GjTW44brTPRlDbBKndTnv6W11hYw3mcTkwDyVRkJyJnr9sTJy0pR!-1547828331!-949856145!8091!-1