• Christopher T Eyeington, Neil J Glassford, Jai Darvall, Andrew Casamento, Tim Haydon, Gopal Taori, Cameron Knott, Forbes McGain, Joseph Vetro, Nick Simpson, Vineet Sarode, Angus Richardson, Charles Dunnachie, Marco Crisman, Jason Musci, Nicholas Woinarski, Rohan Lynham, Glenn M Eastwood, Rinaldo Bellomo, and Dharshi Karalapillai.
• Department of Intensive Care, Austin Health, Melbourne, Vic, Australia.
• Crit Care Resusc. 2018 Jun 1; 20 (2): 101-108.

BackgroundThe setting of tidal volume (VT) during controlled mechanical ventilation (CMV) in critically ill patients without acute respiratory distress syndrome (ARDS) is likely important but currently unknown. We aimed to describe current CMV settings in intensive care units (ICUs) across Victoria.MethodsWe performed a multicentre, prospective, observational study. We collected clinical, ventilatory and arterial blood gas data twice daily for 7 days. We performed subgroup analysis by sex and assessment of arterial partial pressure of carbon dioxide (PaCO2) management where hypercapnia was potentially physiologically contraindicated.ResultsWe recorded 453 observational sets in 123 patients across seven ICUs. The most commonly selected initial VT was 500 mL (33%), and this proportion did not differ according to sex (32% male, 34% female). Moreover, 38% of patients were exposed to initial VT per predicted body weight (VT-PBW) > 8.0 mL/kg. VT-PBW in this range were more likely to occur in females, those with a lower height, lower ideal body weight or in those for whom hypercapnia was potentially physiologically contraindicated. As a consequence, females were more frequently exposed to a lower PaCO2 and higher pH.ConclusionsIn adults without ARDS undergoing CMV in Australian ICUs, the initial VT was a stereotypical 500 mL in one-third of participants, irrespective of sex. Moreover, around 40% of patients were exposed to an initial VT-PBW > 8.0 mL/kg. Finally, women were more likely to be exposed to a high VT and hyperventilation.

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