{
  "id": "medical/ventilator-tidal-volume-ideal-body-weight",
  "signature": "AI calculates ventilator tidal volume using actual body weight instead of ideal body weight, risking volutrauma in ARDS",
  "signature_zh": "AI使用实际体重而非理想体重计算呼吸机潮气量，增加ARDS患者容积伤风险",
  "regex": "(?i)(tidal volume|VT|ventilator).*(actual|current|real|body weight|weight).*(IBW|ideal|predicted|6 mL|6ml)",
  "domain": "medical",
  "category": "data_error",
  "subcategory": null,
  "root_cause": "Lung protective ventilation (ARDSNet protocol) mandates tidal volume of 6 mL/kg of ideal body weight (IBW), not actual body weight. Using actual weight in obese patients (BMI >30) results in tidal volumes >8 mL/kg IBW, causing alveolar overdistension, volutrauma, and increased mortality. IBW is calculated as: Males = 50 + 0.91 × (height in cm − 152.4); Females = 45.5 + 0.91 × (height in cm − 152.4).",
  "root_cause_type": "generic",
  "root_cause_zh": "肺保护性通气（ARDSNet方案）要求潮气量按理想体重（IBW）的6 mL/kg计算，而非实际体重。在肥胖患者（BMI>30）中使用实际体重会导致潮气量>8 mL/kg IBW，引起肺泡过度扩张、容积伤和死亡率增加。IBW计算公式：男性=50+0.91×(身高cm−152.4)；女性=45.5+0.91×(身高cm−152.4)。",
  "versions": [],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "Using actual body weight but capping tidal volume at 500 mL for all adults",
      "why_fails": "A 500 mL cap is too high for a small female (IBW ~45 kg, target VT 270 mL) and too low for a tall male (IBW ~70 kg, target VT 420 mL). It does not account for height or sex.",
      "fail_rate": 0.7,
      "condition": "",
      "sources": []
    },
    {
      "action": "Calculating IBW using a formula that does not subtract 152.4 cm (e.g., using just height × 0.91)",
      "why_fails": "The correct IBW formula includes the 152.4 cm offset; omitting it gives erroneously high IBW for short patients and low IBW for tall patients.",
      "fail_rate": 0.85,
      "condition": "",
      "sources": []
    },
    {
      "action": "Using BMI-based adjustment: 'IBW = actual weight if BMI <30, else use adjusted body weight'",
      "why_fails": "Adjusted body weight is not validated for lung protective ventilation. Only IBW (based on height and sex) is used in ARDSNet trials. Using adjusted weight still overestimates lung size.",
      "fail_rate": 0.75,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "Calculate IBW using the correct formula: For males: IBW (kg) = 50 + 0.91 × (height in cm − 152.4). For females: IBW (kg) = 45.5 + 0.91 × (height in cm − 152.4). Then set initial tidal volume to 6 mL/kg IBW. Adjust to maintain plateau pressure <30 cmH2O. For obese patients, use IBW only; do not use actual body weight.",
      "success_rate": 0.95,
      "how": "Calculate IBW using the correct formula: For males: IBW (kg) = 50 + 0.91 × (height in cm − 152.4). For females: IBW (kg) = 45.5 + 0.91 × (height in cm − 152.4). Then set initial tidal volume to 6 mL/kg IBW. Adjust to maintain plateau pressure <30 cmH2O. For obese patients, use IBW only; do not use actual body weight.",
      "condition": "",
      "sources": []
    },
    {
      "action": "If height cannot be obtained (e.g., unconscious patient), use ulnar length or knee height to estimate height. Alternatively, use a standard IBW of 60 kg for females and 70 kg for males as a temporary measure, but obtain actual height as soon as possible.",
      "success_rate": 0.8,
      "how": "If height cannot be obtained (e.g., unconscious patient), use ulnar length or knee height to estimate height. Alternatively, use a standard IBW of 60 kg for females and 70 kg for males as a temporary measure, but obtain actual height as soon as possible.",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "Calculate IBW using the correct formula: For males: IBW (kg) = 50 + 0.91 × (height in cm − 152.4). For females: IBW (kg) = 45.5 + 0.91 × (height in cm − 152.4). Then set initial tidal volume to 6 mL/kg IBW. Adjust to maintain plateau pressure <30 cmH2O. For obese patients, use IBW only; do not use actual body weight.",
    "If height cannot be obtained (e.g., unconscious patient), use ulnar length or knee height to estimate height. Alternatively, use a standard IBW of 60 kg for females and 70 kg for males as a temporary measure, but obtain actual height as soon as possible."
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.ardsnet.org/",
  "official_doc_section": null,
  "error_code": "ARDSNet-2000-VT",
  "verification_tier": "ai_generated",
  "confidence": 0.89,
  "fix_success_rate": 0.9,
  "resolvable": "true",
  "first_seen": "2024-09-18",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}