Management and outcome of mechanically ventilated patients after cardiac arrest

Management and outcome of mechanically ventilated patients after cardiac arrest.  Critical Care 2015, 19: 215

Sutherasan, Y., et al.

http://ccforum.com/content/pdf/s13054-015-0922-9.pdf

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 Secondary analysis of three prospective, observational multicenter studies conducted in 1998, 2004 and 2010 in 927 intensive care units (ICUs) from 40 countries. We screened 18,302 patients receiving MV for longer than 12 hours during a one-month period. We included 812 patients receiving MV after cardiac arrest. We collected demographics, daily ventilator settings, complications during ventilation and outcomes. Multivariate logistic regression analysis was performed to calculate odds ratios determining that which variables within 24 hours of hospital admission were associated with 28-day hospital mortality and the occurrence of 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) [from a mean 8.9 (standard deviation 2) ml/kg actual body weight (ABW) in 1998 to 6.7(2) ml/kg ABW in 2010 and from 9(2.3) ml/kg predicted body weight (PBW) in 2004 to 7.95(1.7) ml/kg PBW in 2010] and increased positive end-expiratory pressure (PEEP) [from 3.5(3) in 1998 to 6.5(3) in 2010] (p <0.001). Patients included in 2010 had more sepsis, cardiovascular dysfunction and neurologic failure but 28-day hospital mortality was similar over the 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 the occurrence of ARDS and pneumonia acquired during ICU stay. Conclusions: Protective 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.