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Low tidal volume ventilation does not increase sedation use in patients with acute lung injury*

Kahn, Jeremy M. MD; Andersson, Liane RN, CCRN; Karir, Veena PharmD; Polissar, Nayak L. PhD; Neff, Margaret J. MD, MSc; Rubenfeld, Gordon D. MD, MSc

doi: 10.1097/01.CCM.0000157786.41506.24
Clinical Investigations
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Objective: Low tidal volume ventilation is associated with reduced mortality in patients with acute lung injury, yet concerns exist about patient comfort and the levels of sedation and analgesia required during its use. We compared the doses and duration of sedatives and opioid analgesics in patients receiving low vs. traditional tidal volumes at our institution.

Design: Secondary analysis of a randomized clinical trial.

Setting: University-affiliated county hospital in Seattle, WA.

Patients: Sixty-one patients with acute lung injury enrolled in the National Heart, Lung and Blood Institute’s ARDS Network tidal volume trial.

Interventions: None.

Measurements and Main Results: Thirty-three patients were randomized to the lower tidal volume arm (6 mL/kg of predicted body weight) and 28 patients were randomized to the higher tidal volume arm (12 mL/kg of predicted body weight). There were no significant differences in the percentage of study days patients received sedatives, opioids, or neuromuscular blockade. When specific study days were examined, there were no significant differences in the proportion of patients receiving benzodiazepines, propofol, haloperidol, and opioids on days 1, 2, 3, and 7 of mechanical ventilation, nor were there differences in the doses of benzodiazepines and opioids on those days.

Conclusions: At our institution, low tidal volume ventilation was not associated with increased dose or duration of sedatives in patients with acute lung injury. Sedation administration should not be considered a barrier to implementing a lung-protective ventilation strategy.

From the Division of Pulmonary & Critical Care Medicine (JMK, LA, MJN, GDR) and the Department of Pharmacy (VK), Harborview Medical Center, University of Washington, Seattle, WA; and Mountain-Whisper-Light Statistical Consulting (NLP), Seattle, WA.

Supported, in part, by unrestricted educational grants from AstraZeneca Pharmaceuticals (Wilmington, DE) and Advanced Lifeline Services (Louisville, KY); by grants HR46055 and RO1HL67939 from the National Institutes of Health (Bethesda, MD).

© 2005 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins