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Mechanical ventilation with lower tidal volumes does not influence the prescription of opioids or sedatives

Esther K Wolthuis3,1,2*, Denise P Veelo3,1,2, Goda Choi3,1, Rogier M Determann1, Johanna C Korevaar4, Peter E Spronk1,5,6, Michael A Kuiper1,7,6 and Marcus J Schultz3,1,6

Author Affiliations

1 Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

2 Department of Anesthesiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

3 Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

4 Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

5 Department of Intensive Care Medicine, Gelre Hospitals, location Lukas, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands

6 HERMES Critical Care Group, Amsterdam, The Netherlands

7 Department of Intensive Care Medicine, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, The Netherlands

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Critical Care 2007, 11:R77 doi:10.1186/cc5969

Published: 13 July 2007

Abstract

Introduction

We compared the effects of mechanical ventilation with a lower tidal volume (VT) strategy versus those of greater VT in patients with or without acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) on the use of opioids and sedatives.

Methods

This is a secondary analysis of a previously conducted before/after intervention study, which consisting of feedback and education on lung protective mechanical ventilation using lower VT. We evaluated the effects of this intervention on medication prescriptions from days 0 to 28 after admission to our multidisciplinary intensive care unit.

Results

Medication prescriptions in 23 patients before and 38 patients after intervention were studied. Of these patients, 10 (44%) and 15 (40%) suffered from ALI/ARDS. The VT of ALI/ARDS patients declined from 9.7 ml/kg predicted body weight (PBW) before to 7.8 ml/kg PBW after the intervention (P = 0.007). For patients who did not have ALI/ARDS there was a trend toward a decline from 10.2 ml/kg PBW to 8.6 ml/kg PBW (P = 0.073). Arterial carbon dioxide tension was significantly greater after the intervention in ALI/ARDS patients. Neither the proportion of patients receiving opioids or sedatives, or prescriptions at individual time points differed between pre-intervention and post-intervention. Also, there were no statistically significant differences in doses of sedatives and opioids. Findings were no different between non-ALI/ARDS patients and ALI/ARDS patients.

Conclusion

Concerns regarding sedation requirements with use of lower VT are unfounded and should not preclude its use in patients with ALI/ARDS.