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Critical Care
Published in: Critical Care 1/2015

Open Access 01-12-2015 | Research

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, For the VENTILA GROUP

Published in: Critical Care | Issue 1/2015

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Abstract

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 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.
Appendix
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Metadata
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
For the VENTILA GROUP
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2015
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-015-0922-9

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