Categorical variables were presented as proportions or percentages. The presence of a normal distribution was assessed graphically. We performed a descriptive statistical analysis of the patients’ characteristics, presenting continuous variables as means ± sd, if normally distributed, or as medians and interquartile range, if not normally distributed. Exposed Vt were analyzed in three categories as suggested by Needham et al ( 12): less than 6.5, 6.5–8.5, and greater than 8.5 mL/Kg PBW. This last step originated the equivalent Vt (exposed Vt) that the patient would be exposed to if the visual height estimation was followed to calculate the PBW and the Vt. If the patients needed to be mechanically ventilated, only the real heights measured with the calliper were used to calculate the Vt to deliver.įinally, we divided every Vt calculated from the visual height estimates by the real PBW derived from the measured height (formula below). The resulting PBWs were used to calculate the Vt to use during protective ventilation by being multiplied by 6 mL/Kg. Height estimations and measurements were used to calculate the PBW for every patient using the Devine’s formulas ( 3). Every height measurements and estimations were registered in cm. Finally, an exact crown-to-heel measurement of the patient’s real height, in dorsal decubitus and with the bed at 0°, was performed with a measuring 215-cm calliper. We then collected the patient’s own height estimation or, when impossible, the patient’s visual height estimation from a next of kin. All nurses taking part in the study were experienced in intensive care. The physicians who performed the estimations were four residents and eight senior intensivists. The physician was blinded to the nurse estimation and vice versa. To address this issue, we designed this study with the aim of evaluating the impact of visual height estimation on Vt calculation to use during protective ventilation.įor every enrolled patient, we collected information on demographics (age, gender), typology of admission (medical vs surgical), worse registered value of two severity/prognostic scores during the first 24 hours of ICU admission (Acute Physiology and Chronic Health Evaluation II and Simplified Acute Physiology Score II ), and the patient’s visual height estimation from the physician and the nurse who performed the admission. The delivery of unsafe Vt during invasive mechanical ventilation, with potentially deleterious effects on patient outcome, may be one of those consequences. We hypothesize that visual height estimation may lead to errors in height assessment with multiple clinical repercussions. ![]() Yet, little is known about the potential impact of errors arising from visual height estimation to calculate Vt to use during protective ventilation. Previous studies ( 7– 9) demonstrated that direct visual PBW estimation is common and often leads to the administration of Vt outside the protective ventilation range. ![]() Unfortunately, both height and PBW are mostly estimated during the assessment of critically ill patients at bedside, and these estimations are thought to be biased and inaccurate ( 4– 6). Female: PBW = 45.5 + 0.91 × (height in cm–152.4) KgĪs shown, these formulas depend on the patient’s height.
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