Abstract
IntroductionThe 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.MethodsWe 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.ResultsAmong 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.ConclusionsProtective mechanical ventilation with lower VT and 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0922-9) contains supplementary material, which is available to authorized users.
Highlights
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
Factors associated with acute respiratory distress syndrome and intensive care unit (ICU)-acquired pneumonia At multivariate analysis, in patients without lung injury at admission, the potential risk factor for the development of ARDS 48 hours after ICU stay was higher plateau pressure, while those associated with ICU pneumonia acquired during ICU stay were higher tidal volume and lower applied positive end-expiratory pressure (PEEP) levels
We investigated variables associated with 28-day hospital mortality and the occurrence of ARDS and/or pneumonia acquired during ICU stay among cardiac arrest patients undergoing mechanical ventilation
Summary
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. Many studies in patients after cardiac arrest with return of spontaneous circulation (ROSC) focus on how to improve survival and neurological outcomes. Despite several interventions, such as targeted temperature management [1,2,3,4], vasopressor drugs [5], control of seizures and blood sugar level [6], poor neurological outcome and mortality are still as high as 50% [4,7,8]. The characteristics and the influence of ventilator settings, that is, tidal volume and positive end-expiratory pressure (PEEP), on organ failure and outcome of patients after cardiac arrest have not been previously described
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