Abstract
BackgroundThe lung-protective ventilation bundle has been shown to reduce mortality in adult acute respiratory distress syndrome (ARDS). This concept has expanded to other areas of acute adult ventilation and is recommended for pediatric ventilation. A component of lung-protective ventilation relies on a prediction of lean body weight from height. The predicted body weight (PBW) relationship employed in the ARDS Network trial is considered valid only for adults, with a dedicated formula required for each sex. No agreed PBW formula applies to smaller body sizes. This analysis investigated whether it might be practical to derive a unisex PBW formula spanning all body sizes, while retaining relevance to established adult protective ventilation practice.MethodsHistoric population-based growth charts were adopted as a reference for lean body weight, from pre-term infant through to adult median weight. The traditional ARDSNet PBW formulae acted as the reference for prevailing protective ventilation practice. Error limits for derived PBW models were relative to these references.ResultsThe ARDSNet PBW formulae typically predict weights heavier than the population median, therefore no single relationship could satisfy both references. Four alternate piecewise-linear lean body-weight predictive formulae were presented for consideration, each with different balance between the objectives.ConclusionsThe ‘PBWuf + MBW’ model is proposed as an appropriate compromise between prevailing practice and simplification, while also better representing lean adult body-weight. This model applies the ARDSNet ‘female’ formula to both adult sexes, while providing a tight fit to median body weight at smaller statures down to pre-term. The ‘PBWmf + MBW’ model retains consistency with current practice over the adult range, while adding prediction for small statures.
Highlights
The lung-protective ventilation bundle has been shown to reduce mortality in adult acute respiratory distress syndrome (ARDS)
A ‘lung-protective strategy’ is increasingly the standard of care for acute ventilation based on data showing that this approach to treating acute respiratory distress syndrome (ARDS) in adults was associated with reduced mortality [1,2,3]
The clinical robustness of using predicted weight rather than actual weight in infants may be questioned: will any potential safety benefits be confounded by the particular challenge of measuring length in babies, or the complication of the prediction process? The analysis presented here does not touch on this question, but defers to the recent consensus recommendation [6] in favor of using predicted body weight in pediatric ventilation, and offers a means of doing so without reference to growth charts
Summary
The lung-protective ventilation bundle has been shown to reduce mortality in adult acute respiratory distress syndrome (ARDS). This concept has expanded to other areas of acute adult ventilation and is recommended for pediatric ventilation. Mechanical ventilation was initiated with a tidal volume based on a patient’s actual body weight, which was believed to reflect metabolic need. This remains common practice for pediatric ventilation, and for much of adult ventilation.
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