Ventilatory settings in the initial 72 h and their association with outcome in out-of-hospital cardiac arrest patients: a preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial

Chiara Robba, Rafael Badenes, Gisela Lilja, Hans Friberg, Michelle S. Chew, Johan Unden, Andreas Lundin, Martin Annborn, Josef Dankiewicz, Niklas Nielsen, Paolo Pelosi, Tobias Cronberg (medarbetare), David Erlinge (medarbetare), Helena Levin (medarbetare), Per Nordberg (medarbetare), Susann Ullén, Karolina Palmér (medarbetare), Ulla Britt Karlsson (medarbetare), Simon Heissler (medarbetare), Ameldina Ceric (medarbetare)Zana Haxhija (medarbetare), Joachim Düring (medarbetare), Mattias Bergström (medarbetare), Ingrid Didriksson (medarbetare), Petrea Frid (medarbetare), Katarina Heimburg (medarbetare), Oscar Lundberg (medarbetare), Stefan Olsson Hau (medarbetare), Simon Schmidbauer (medarbetare), Ola Borgquist (medarbetare), Anna Bjärnroos (medarbetare), Erik Blennow Nordström (medarbetare), Irina Dragancea (medarbetare), Thomas Kander (medarbetare), Anna Lybeck (medarbetare), Gustav Mattiasson (medarbetare), Olof Persson (medarbetare), Malin Rundgren (medarbetare), Erik Westhall (medarbetare), Sara Andertun (medarbetare), Florian Ebner (medarbetare), Jesper Johnsson (medarbetare), on behalf of the TTM2 Trial Collaborators

Forskningsoutput: TidskriftsbidragArtikel i vetenskaplig tidskriftPeer review

Sammanfattning

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.

Originalspråkengelska
Sidor (från-till)1024-1038
Antal sidor15
TidskriftIntensive Care Medicine
Volym48
Nummer8
DOI
StatusPublished - 2022 aug.

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© 2022, The Author(s).

Ämnesklassifikation (UKÄ)

  • Kardiologi
  • Anestesi och intensivvård

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