Observational studyCritical care medicine2019
Evaluating Delivery of Low Tidal Volume Ventilation in Six ICUs Using Electronic Health Record Data.
Observational study in Critical care medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03909854 (Pragmatic Investigation of Volume Targeted Ventilation-1), which is not on this map. Cited by 23 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Pragmatic Investigation of Volume Targeted Ventilation-1 (PIVOT-1)
Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it, 43 citations in OpenAlex.
- Electronic "Sniffer" Systems to Identify the Acute Respiratory Distress Syndrome.Annals of the American Thoracic Society · 2019Pooled it
- Delivery of Lung-protective Ventilation for Acute Respiratory Distress Syndrome: A Hybrid Implementation-Effectiveness Trial.Annals of the American Thoracic Society · 2023Trial
- ICU Implementation Determinants and Delivery of Lung Protective Ventilation: A Multihospital Survey and Cohort Study.CHEST critical care · 2026Article
- Effects of secular changes in tidal volume and respiratory rate on the mechanical power of ventilation: a retrospective single-center study of invasively ventilated patients.Critical care science · 2025Article
- ARDS, guidelines and ANZ practice: The persistent disconnect.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2024Article
- Respiratory Therapist-Driven Mechanical Ventilation Protocol Is Associated With Increased Lung Protective Ventilation.Respiratory care · 2024Article
- Assessing Evidence-Based Practice Knowledge, Self-Efficacy, and Use Among Respiratory Therapists.Respiratory care · 2024Article
- Article
- Article
- Article
- Shortening the Journey from Evidence to Practice: The Benefits and Complexities of Hybrid Implementation-effectiveness Trials.Annals of the American Thoracic Society · 2023Article
- Driving Pressure, Elastance, and Outcomes in a Real-World Setting: A Bi-Center Analysis of Electronic Health Record Data.Critical care explorations · 2023Article
- Elevated Driving Pressure and Elastance Does Not Increase In-Hospital Mortality Among Obese and Severely Obese Patients With Ventilator Dependent Respiratory Failure.Critical care explorations · 2022Article
- An alert tool to promote lung protective ventilation for possible acute respiratory distress syndrome.JAMIA open · 2022Article
- Improving delivery of low tidal volume ventilation in 10 ICUs.BMJ open quality · 2022Article
- Observational
- A Target for Increased Mortality Risk in Critically Ill Patients: The Concept of Perpetuity.Journal of clinical medicine · 2021Article
- Implementing nudges to promote utilization of low tidal volume ventilation (INPUT): a stepped-wedge, hybrid type III trial of strategies to improve evidence-based mechanical ventilation management.Implementation science : IS · 2021Article
- Lung-Protective Ventilation Over 6 Years at a Large Academic Medical Center: An Evaluation of Trends, Adherence, and Perceptions of Benefit.Critical care explorations · 2021Article
- Causes and characteristics of death in patients with acute hypoxemic respiratory failure and acute respiratory distress syndrome: a retrospective cohort study.Critical care (London, England) · 2020Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
Abstract
objectivesMechanical ventilation with low tidal volumes is recommended for all patients with acute respiratory distress syndrome and may be beneficial to other intubated patients, yet consistent implementation remains difficult to obtain. Using detailed electronic health record data, we examined patterns of tidal volume administration, the effect on clinical outcomes, and alternate metrics for evaluating low tidal volume compliance in clinical practice.
designObservational cohort study.
settingSix ICUs in a single hospital system. PATIENTS: Adult patients who received invasive mechanical ventilation more than 12 hours.
interventionsNone. MEASUREMENTS AND MAIN
resultsTidal volumes were analyzed across 1,905 hospitalizations. Although mean tidal volume was 6.8 mL/kg predicted body weight, 40% of patients were exposed to tidal volumes greater than 8 mL/kg predicted body weight, with 11% for more than 24 hours. At a patient level, exposure to 24 total hours of tidal volumes greater than 8 mL/kg predicted body weight was associated with increased mortality (odds ratio, 1.82; 95% CI, 1.20-2.78), whereas mean tidal volume exposure was not (odds ratio, 0.87/1 mL/kg increase; 95% CI, 0.74-1.02). Initial tidal volume settings strongly predicted exposure to volumes greater than 8 mL/kg for 24 hours; the adjusted rate was 21.5% when initial volumes were greater than 8 mL/kg predicted body weight and 7.1% when initial volumes were less than 8 mL/kg predicted body weight. Across ICUs, correlation of mean tidal volume with alternative measures of low tidal volume delivery ranged from 0.38 to 0.66.
conclusionsDespite low mean tidal volume in the cohort, a significant percentage of patients were exposed to a prolonged duration of high tidal volumes which was correlated with higher mortality. Detailed ventilator records in the electronic health record provide a unique window for evaluating low tidal volume delivery and targets for improvement.
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