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Title: Management and outcome of mechanically ventilated patients after cardiac arrest
Authors: Yuda Sutherasan
Oscar Peñuelas
Alfonso Muriel
Maria Vargas
Fernando Frutos-Vivar
Iole Brunetti
Konstantinos Raymondos
Davide D'Antini
Niklas Nielsen
Niall D. Ferguson
Bernd W. Böttiger
Arnaud W. Thille
Andrew R. Davies
Javier Hurtado
Fernando Rios
Carlos Apezteguía
Damian A. Violi
Nahit Cakar
Marco González
Bin Du
Michael A. Kuiper
Marco Antonio Soares
Younsuck Koh
Rui P. Moreno
Pravin Amin
Vinko Tomicic
Luis Soto
Hans Henrik Bülow
Antonio Anzueto
Andrés Esteban
Paolo Pelosi
Mahidol University
Ospedale Policlinico San Martino
Hospital Universitario Infanta Cristina and CIBER Enfermedades Respiratorias
Hospital Ramon y Cajal
Universita degli Studi di Napoli Federico II
Hospital Universitario de Getafe
Medizinische Hochschule Hannover (MHH)
Universita degli Studi di Foggia
Helsingborgs Lasarett
University of Toronto
Uniklinik Koln
Universite de Poitiers
Monash University
Hospital de Clinicas Dr. Manuel Quintela
Hospital Nacional Professor Dr. Alejandro Posadas
Prof. Dr. Luis Güemes General Hospital
Istanbul Tip Fakultesi
Universidad Pontificia Bolivariana
Peking Union Medical College
Medisch Centrum Leeuwarden
Hospital Universitário São José
University of Ulsan, College of Medicine
Hospital de Sao Jose
Bombay Hospital and Medical Research Centre
Clinica Las Lilas
Instituto Nacional del Torax
Kobenhavns Universitet
University of Texas Health Science Center at San Antonio
Keywords: Medicine
Issue Date: 14-Dec-2015
Citation: Critical Care. Vol.19, No.1 (2015)
Abstract: © 2015 Sutherasan et al. Introduction: The aim of this study was to describe and compare the changes in ventilator management and complications over time, as well as variables associated with 28-day hospital mortality in patients receiving mechanical ventilation (MV) after cardiac arrest. Methods: We performed a secondary analysis of three prospective, observational multicenter studies conducted in 1998, 2004 and 2010 in 927 ICUs from 40 countries. We screened 18,302 patients receiving MV for more than 12 hours during a one-month-period. We included 812 patients receiving MV after cardiac arrest. We collected data on demographics, daily ventilator settings, complications during ventilation and outcomes. Multivariate logistic regression analysis was performed to calculate odds ratios, determining which variables within 24 hours of hospital admission were associated with 28-day hospital mortality and occurrence of acute respiratory distress syndrome (ARDS) and pneumonia acquired during ICU stay at 48 hours after admission. Results: Among 812 patients, 100 were included from 1998, 239 from 2004 and 473 from 2010. Ventilatory management changed over time, with decreased tidal volumes (VT) (1998: mean 8.9 (standard deviation (SD) 2) ml/kg actual body weight (ABW), 2010: 6.7 (SD 2) ml/kg ABW; 2004: 9 (SD 2.3) ml/kg predicted body weight (PBW), 2010: 7.95 (SD 1.7) ml/kg PBW) and increased positive end-expiratory pressure (PEEP) (1998: mean 3.5 (SD 3), 2010: 6.5 (SD 3); P <0.001). Patients included from 2010 had more sepsis, cardiovascular dysfunction and neurological failure, but 28-day hospital mortality was similar over time (52% in 1998, 57% in 2004 and 52% in 2010). Variables independently associated with 28-day hospital mortality were: older age, PaO2<60 mmHg, cardiovascular dysfunction and less use of sedative agents. Higher VT, and plateau pressure with lower PEEP were associated with occurrence of ARDS and pneumonia acquired during ICU stay. Conclusions: Protective mechanical ventilation with lower VTand higher PEEP is more commonly used after cardiac arrest. The incidence of pulmonary complications decreased, while other non-respiratory organ failures increased with time. The application of protective mechanical ventilation and the prevention of single and multiple organ failure may be considered to improve outcome in patients after cardiac arrest.
ISSN: 1466609X
Appears in Collections:Scopus 2011-2015

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