TY - JOUR
T1 - Ventilatory settings in the initial 72 h and their association with outcome in out-of-hospital cardiac arrest patients
T2 - a preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial
AU - Robba, Chiara
AU - Badenes, Rafael
AU - Lilja, Gisela
AU - Friberg, Hans
AU - Chew, Michelle S.
AU - Unden, Johan
AU - Lundin, Andreas
AU - Annborn, Martin
AU - Dankiewicz, Josef
AU - Nielsen, Niklas
AU - Pelosi, Paolo
AU - Ullén, Susann
AU - on behalf of the TTM2 Trial Collaborators
A2 - Cronberg, Tobias
A2 - Erlinge, David
A2 - Levin, Helena
A2 - Nordberg, Per
A2 - Palmér, Karolina
A2 - Karlsson, Ulla Britt
A2 - Heissler, Simon
A2 - Ceric, Ameldina
A2 - Haxhija, Zana
A2 - Düring, Joachim
A2 - Bergström, Mattias
A2 - Didriksson, Ingrid
A2 - Frid, Petrea
A2 - Heimburg, Katarina
A2 - Lundberg, Oscar
A2 - Hau, Stefan Olsson
A2 - Schmidbauer, Simon
A2 - Borgquist, Ola
A2 - Bjärnroos, Anna
A2 - Blennow Nordström, Erik
A2 - Dragancea, Irina
A2 - Kander, Thomas
A2 - Lybeck, Anna
A2 - Mattiasson, Gustav
A2 - Persson, Olof
A2 - Rundgren, Malin
A2 - Westhall, Erik
A2 - Andertun, Sara
A2 - Ebner, Florian
A2 - Johnsson, Jesper
N1 - Funding Information:
MS, receiving consulting fees from Bard Medical; PJY, receiving lecture fees from Bard Medical; FST, receiving grant support from Bard Medical and ZOLL Medical; AN, receiving grant support, paid to University College Dublin, from AM Pharma and grant sup-port, paid to Monash University, from Baxter Healthcare; MSC, receiving lecture fees from Edwards Lifesciences; HF, receiving fees for academic advising from TEQCool; and NN, receiving lecture fees from Bard Medical and consulting fees from BrainCool. RB is supported by INCLIVA. No other potential conflict of interest relevant to this article was reported.
Funding Information:
Open access funding provided by Università degli Studi di Genova within the CRUI-CARE Agreement. The TTM2 trial was supported by independent research grants from nonprofit or governmental agencies (the Swedish Research Council [Veten-skapsrådet], Swedish Heart–Lung Foundation, Stig and Ragna Gorthon Foundation, Knutsson Foundation, Laerdal Foundation, Hans-Gabriel and Alice Trolle-Wachtmeister Foundation for Medical Research, and Regional Research Support in Region Skåne) and by governmental funding of clinical research within the Swedish National Health Service. No further fundings were requested for this subanalysis.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/8
Y1 - 2022/8
N2 - 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 (VT) 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) cmH20, plateau pressure was 20 cmH20 (IQR = 17–23), driving pressure was 12 cmH20 (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.
AB - 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 (VT) 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) cmH20, plateau pressure was 20 cmH20 (IQR = 17–23), driving pressure was 12 cmH20 (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.
KW - Cardiac arrest
KW - Driving pressure
KW - Mechanical power
KW - Mechanical ventilation
KW - Outcome
KW - Ventilator settings
U2 - 10.1007/s00134-022-06756-4
DO - 10.1007/s00134-022-06756-4
M3 - Article
C2 - 35780195
AN - SCOPUS:85133282899
SN - 0342-4642
VL - 48
SP - 1024
EP - 1038
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 8
ER -