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OBJECTIVE Portable chest radiographs (CRs) are obtained routinely in mechanically ventilated patients, but little is known about relationships between CR findings and ventilator parameters. It is unclear whether radiographically apparent hyperinflation correlates with tidal volume (VT), body weight (BW), VT/kg, or levels of peak airway pressure (PAP), positive end-expiratory pressure (PEEP), or pressure support (PS). METHODS Prospective comparison of CR and ventilator parameters in 62 mechanically ventilated patients in surgical and medical intensive care units of a university hospital. METHODS All mechanically ventilated adults with portable CR on four separate dates. METHODS Chest radiographs were classified by subjective assessments as hyperinflated (H+) or nonhyperinflated (H-), independent of knowledge of patients or their mechanical ventilation. Chest radiographs were reclassified independently as H+, H-, or indeterminate by a radiologist using objective criteria. Ventilator parameters recorded at the time of the CR were obtained and compared. RESULTS Patients with CRs classified subjectively as H+ compared with patients with CRs classified as H- had a larger VT/kg (12.0 +/- 0.4 ml/kg [mean +/- SEM] vs 10.2 +/- 0.4; p = 0.004), lower BW (70.8 +/- 2.9 kg vs 81.5 +/- 3.8; p = 0.03), higher PEEP (6.5 +/- 0.5 cm H2O vs 5.0 +/- 0.4; p = 0.01), and higher PAP (38.2 +/- 2.1 cm H2O vs. 33.4 +/- 1.8; p = 0.06). Using objective CR classifications, patients with H+ CRs had a VT/kg of 12.6 +/- 0.4, larger than in the indeterminate (11.1 +/- 0.8) and H- (9.9 +/- 0.3) groups (p < 0.001). The BW differed among objectively classified groups (66.5 +/- 2.7 H+, 68.9 +/- 5.1 indeterminate, and 85.2 +/- 3.7 H-; p < 0.001), but other ventilator parameters did not correlate univariately with the degree of inflation on CR. Multivariate analysis showed that higher VT was predictive of H+ after adjusting for BW in subjective (p = 0.076) and objective (p = 0.017) classifications. PEEP (p = 0.004) and older age (p = 0.021) were also associated with H+ in multivariate analysis. Four of 25 (16 percent) patients with objectively H+ CRs developed barotrauma, while no patient with H- CR had this complication (p = 0.037). CONCLUSIONS In mechanically ventilated patients, hyperinflation seen on portable CR is associated with higher VT, VT/kg, and lower BW, and may help predict subsequent barotrauma.
E W Ely, and
D L Bowton, and
J C Reed, and
L D Case, and
E F Haponik
February 1984,
AJR. American journal of roentgenology,
E W Ely, and
D L Bowton, and
J C Reed, and
L D Case, and
E F Haponik
May 1988,
Chest,
E W Ely, and
D L Bowton, and
J C Reed, and
L D Case, and
E F Haponik
January 2013,
Radiologic technology,
E W Ely, and
D L Bowton, and
J C Reed, and
L D Case, and
E F Haponik
January 2015,
Anaesthesia and intensive care,
E W Ely, and
D L Bowton, and
J C Reed, and
L D Case, and
E F Haponik
March 2002,
Emergency radiology,
E W Ely, and
D L Bowton, and
J C Reed, and
L D Case, and
E F Haponik
January 1998,
The Journal of thoracic and cardiovascular surgery,
E W Ely, and
D L Bowton, and
J C Reed, and
L D Case, and
E F Haponik
December 1979,
Journal of applied physiology: respiratory, environmental and exercise physiology,
E W Ely, and
D L Bowton, and
J C Reed, and
L D Case, and
E F Haponik
April 2022,
Physiotherapy research international : the journal for researchers and clinicians in physical therapy,
E W Ely, and
D L Bowton, and
J C Reed, and
L D Case, and
E F Haponik
August 1993,
Investigative radiology,
E W Ely, and
D L Bowton, and
J C Reed, and
L D Case, and
E F Haponik
July 1978,
AJR. American journal of roentgenology,
