Journal
INTENSIVE CARE MEDICINE
Volume 48, Issue 8, Pages 1024-1038Publisher
SPRINGER
DOI: 10.1007/s00134-022-06756-4
Keywords
Mechanical ventilation; Cardiac arrest; Outcome; Mechanical power; Driving pressure; Ventilator settings
Categories
Funding
- Universita degli Studi di Genova
- Swedish Research Council [Vetenskapsradet]
- Swedish Heart-Lung Foundation
- Stig and Ragna Gorthon Foundation
- Knutsson Foundation
- Laerdal Foundation
- Hans-Gabriel and Alice Trolle-Wachtmeister Foundation for Medical Research
- Region Skane
- Swedish National Health Service
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This study aimed to describe the ventilatory settings applied in the first 72 hours of mechanical ventilation in patients after out-of-hospital cardiac arrest and their association with 6-month outcomes. The results showed that respiratory rate, driving pressure, and mechanical power were independently associated with 6-month mortality, and respiratory rate and driving pressure were also independently associated with poor neurological outcome.
Purpose The optimal ventilatory settings in patients after cardiac arrest and their association with outcome remain unclear. The aim of this study was to describe the ventilatory settings applied in the first 72 h of mechanical ventilation in patients after out-of-hospital cardiac arrest and their association with 6-month outcomes. Methods Preplanned sub-analysis of the Target Temperature Management-2 trial. Clinical outcomes were mortality and functional status (assessed by the Modified Rankin Scale) 6 months after randomization. Results A total of 1848 patients were included (mean age 64 [Standard Deviation, SD = 14] years). At 6 months, 950 (51%) patients were alive and 898 (49%) were dead. Median tidal volume (V-T) was 7 (Interquartile range, IQR = 6.2-8.5) mL per Predicted Body Weight (PBW), positive end expiratory pressure (PEEP) was 7 (IQR = 5-9) cmH(2)0, plateau pressure was 20 cmH(2)0 (IQR = 17-23), driving pressure was 12 cmH(2)0 (IQR = 10-15), mechanical power 16.2 J/min (IQR = 12.1-21.8), ventilatory ratio was 1.27 (IQR = 1.04-1.6), and respiratory rate was 17 breaths/minute (IQR = 14-20). Median partial pressure of oxygen was 87 mmHg (IQR = 75-105), and partial pressure of carbon dioxide was 40.5 mmHg (IQR = 36-45.7). Respiratory rate, driving pressure, and mechanical power were independently associated with 6-month mortality (omnibus p-values for their non-linear trajectories: p < 0.0001, p = 0.026, and p = 0.029, respectively). Respiratory rate and driving pressure were also independently associated with poor neurological outcome (odds ratio, OR = 1.035, 95% confidence interval, CI = 1.003-1.068, p = 0.030, and OR = 1.005, 95% CI = 1.001-1.036, p = 0.048). A composite formula calculated as [(4*driving pressure) + respiratory rate] was independently associated with mortality and poor neurological outcome. Conclusions Protective ventilation strategies are commonly applied in patients after cardiac arrest. Ventilator settings in the first 72 h after hospital admission, in particular driving pressure and respiratory rate, may influence 6-month outcomes.
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