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.
Details
State: Public
Version: Final published version
License: Not specified
Serval ID
serval:BIB_7000CBA5D67C
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
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.
Journal
Intensive care medicine
Working group(s)
TTM2 Trial Collaborators
Contributor(s)
Nielsen N., Bělohlávek J., Callaway C., Cariou A., Cronberg T., Dankiewicz J., Eastwood G., Erlinge D., Friberg H., Hovdenes J., Jakobsen J.C., Joannidis M., Kirkegaard H., Levin H., Lilja G., Morgan MPG, Nichol A.D., Nordberg P., Oddo M., Pelosi P., Rylander C., Saxena M., Storm C., Taccone F.S., Ullén S., Wise M.P., Young P.J., Rowan K., Harrison D., Mouncey P., Shankar-Hari M., Young D., Ullén S., Lange T., Palmér K., Karlsson U.B., Heissler S., Bass F., Hammond N., Myburgh J., Taylor C., Bellino A., Abel-All M., Finfer B., Koch C., Li Y., O'Connor A., Pilowsky J., Schneider T., Tippett A., Ady B., Broadley T., Brown A., Melgaard L., Morgan M., Singh V., Symons R., Becker K., Van Sante N., Saleova V., Zerzanova S., Levin H., Sefir-Kribel S., Lübeck U., Negri M., Carrara M., Fernando K., Mackle D., Navarra L., Riley J., Westerheim E., Flatebø M., Ceric A., Haxhija Z., Terling L., Bossmar L., Jergle L., Månsson H.H., Maillard S.A., Zagar A.V., Jodlauk C., Hill H., Scrivens J., Ainscough K., Fahey C., Bellomo R., Peck L., Young H., Cheung W., Cross R., Hayes M., Jain N., Kol M., Shah A., Wagh A., Wong H., Martinez F.E., Brinkerhoff G., Bush D., Stewart A., Aneman A., Lombardo L., McCanny P., Penketh J., Seppelt I., Gresham R., Lowrey J., Masters K., Whitehead C., Walsham J., Harward M., Mackay J., Meyer J., Saylor E., Venz E., Wetzig K., Stedman W., Ashelford A., Mar S., Pilowsky J., Tokumitsu M., Yarad E., Buscher H., Reynolds C., Udy A., Burrell A., Collins J., Gantner D., Martin V.E., Mccracken P., Nanjayya V., Nichol A., Richardson A.S., Young M., Ghosh A., Said S., Joannidis M., Beer R., Hartig F., Helbok R., Klein S., Peer A., Taccone F.S., Creteur J., Durand D., Dupont M., Christiaens S., Claes C., Deckx S., Ferdinande B., Lenaerts S., Mullens W., Stroobants S., Theunissen E., Verhaert D., Šmíd O., Flaksa M., Kemlink D., Malík J., Otáhal M., Rulíšek J., Šíranec M., Stach Z., Valeriánová A., Zavadilova P., Solař M., Bánszky R., Červená J., Pařízková R.Č., Šimůnek L., Varhaník F., Karásek J., Strýček M., Grejs A., Christensen S., Juhl-Olsen P., Thomsen I.K., Østergaard L.G., Cariou A., Cao A., Dupland P., Gavaud A., Jaubert P., Jozwiak M., Marin N., Savary G., Deye N., Megarbane B., Mora P., Sutterlin L., Legriel S., Bellut H., Ferre A., Lacave G., Lascarrou MPJ, Canet E., Garret C., Miaihle A.F., Reignier J., Vignon P., Daix T., Desachy A., Evrard B., Francois B., Fedou A.L., Goudelin M., Storm C., Kress G., Leithner C., Nee J., Streitberger K.J., Brunetti I., Ball L., Battaglini D., Bonatti G., Firpo I., Frisoni P., Iachi A., Maiani S., Mandelli M., Robba C., Tarantino F., Barbieri A., Bertellini E., Giuliani E., Melegari G., Roman-Pognuz E., Berlot G., Lucangelo U., Macchini E., Hovdenes J., Aune V., Drægni T., Jacobsen S., Pieschke S., Rasmussen Å., Akselsen G.R., Langeland H., Bergum D., Erbe T.M., Klepstad P., Næss H.M., Olsen R.B., Skjelnes L.E., Holen M., Post J.I., Fanebust R., Sørensen L.H., Kårstad K.Å., Wickman C.F., Young P., Barnes C., Barry B., Beehre N., Dinsdale D., Edney S., Hunt A., Judd H., Latimer-Bell C., Lawrence C., Moore J., Olatunji S., Psirides A., Robinson C., Tietjens K., Wright J., Knight D., Birker B., Bowie D., Burke T., Closey D., Crombie R., Davidson N., Henderson S., Hitchings L., McKay J., Mehrtens J., Minto E., Morgan S., Morris A., Ritzemar-Carter J., Roberts J., Shaw G., Townend K., Vander Heyden K., Rylander C., Ahlqvist M., Lindgren R.D., Eiving I., Lundin A., Martner P., Myhrman E., Ryding B., Düring J., Bergström M., Bohm M., Didriksson I., Frid P., Heimburg K., Larsson M., Lundberg O., Hau S.O., Schmidbauer S., Borgquist O., Adolfsson A., Bjärnroos A., Blennow-Nordström E., Dragancea I., Kander T., Lybeck A., Mattiasson G., Persson O., Rundgren M., Schrey S., Westhall E., Annborn M., Andertun S., Ebner F., Gustavsson N., Hassel L., Johnsson J., Nelderup M., Petersson H., Petersson J., Stafilidou F., Undén J., Antonsson F., Bergman G., Gamroth J., Meirik M., Rudolfsson K., Sandberg H., Thorsson M., Savolainen K., Hansbo M., Helliksson M., Nödtveidt B., Sanner J., Sem V., Lindquist C.S., Awad A., Börjesson A.S., Hedberg M., Henning M., Hollenberg J., Petersen P., Dahlberg E., Forshammar J., Svensson V., Wanecek M., Eskilsson H., Rodriguez-Santos D., Appelqvist Å., Jidbratt H., Johansson E., Kiszakiewicz L., Nilsson Å., Olsson S., Paulsson A., Stempel U., Thoren A., Persson S., Berglund I., Bergström E., Törnqvist C., Östman I., Rubertsson S., Larsson I.M., Söderman E., Wallin E., Wessbergh J., Halliday T., Engvall F., Oddo M., Ben-Hamouda N., Bernini A., Carron P.N., Eckert P., Favre E., Miroz J.P., Morelli P., Muller O., Novi J., Rosseti A., Schnorf M., Haenggi M., Levis A., Nansoz S., Söll N., Schrag C., Alicajic M., Baier P., Dütschler J., Flügel D., Fässler E., Gamio-Veis R., Güpfert M., Hilpertshauser Y., Hägele-Link S., Kleger G.R., Krähenmann P., Mair M.E., Schai N., Strohmaier C., Tangl P., Zieglgänsberger D., Maggiorini M., Claus G., Consani-Vogel G., Imbach L., Kaiser S., Kleinert E.M., Wendel Garcia P.D., Cassina T., Agazzi P., Capelli B., Casso G., Regazzi M., Schlotterbeck H., Via G., Villa M., Wise M.P., Brooks J., Cocks E., Cole J., Curtin J., Davies M., Davies R., Fernandez S., Highfield J., Hill H., Morgan MPG, Pennant L., Rose S., Thomas E., Williams A., McGuigan P., Haffey S., O'Neill A., Ward K., Thomas M., Bewley J., Chillingworth A., Cloake J., Cole L., Galvin H., Garland Z., Grimmer L., Gumbrill B., Howie L., Johnson R., Searles C., Skorko A., Sweet K., Taylor V., Webster D., Keeble T., Adams G., Aggarwal R.K., Cartwright J.A., Church S., Clesham G.J., Davies J.R., Farrell K., Gamma R., Harding J., Jagathesan R., Kabir A., Kelly P.A., Kittridge L., Maccaroni M., Maloney G., Mion M., Nain N., Nalgirkar R., Namjoshi G., Pepper S., Redman E., Robinson N.M., Sayer J., Solesbury A., Tang K.H., Urovi S., Waghmare K., Watson N., Webber T., Isherwood P., Bentley C., Bergin C., Carrera R., Clark A., Cooper L., Despy L., Dooley N., Ellis K., Fellows E., Goundry S., Harkett S., McGhee C., Neal A., Smith H., Snelson C., Spruce E., Whitehouse T., Yakoub K., Walden A., Bartley S., Bhuie P., Frise M., Jacques N., Keating L., Pogson D., Daly Z., Rose S., Bannard-Smith J., Quayle R., Chee N., Barratt N., Bowman K., Branney D., Howe E., Letts M., Pitts S., Vamplew L., Callaway C.W., Sprouse S.D., Doshi A.A., Fugate J., Headlee A.M., Wijdicks EFM
ISSN
1432-1238 (Electronic)
ISSN-L
0342-4642
Publication state
Published
Issued date
08/2022
Peer-reviewed
Oui
Volume
48
Number
8
Pages
1024-1038
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Publication Status: ppublish
Abstract
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.
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.
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 (V <sub>T</sub> ) 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) cmH <sub>2</sub> 0, plateau pressure was 20 cmH <sub>2</sub> 0 (IQR = 17-23), driving pressure was 12 cmH <sub>2</sub> 0 (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.
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.
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.
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 (V <sub>T</sub> ) 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) cmH <sub>2</sub> 0, plateau pressure was 20 cmH <sub>2</sub> 0 (IQR = 17-23), driving pressure was 12 cmH <sub>2</sub> 0 (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.
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.
Keywords
Humans, Hypothermia/complications, Middle Aged, Out-of-Hospital Cardiac Arrest/complications, Respiration, Artificial, Tidal Volume, Ventilators, Mechanical, Cardiac arrest, Driving pressure, Mechanical power, Mechanical ventilation, Outcome, Ventilator settings
Pubmed
Web of science
Open Access
Yes
Create date
02/10/2022 23:25
Last modification date
25/01/2024 8:38
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