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,Intensive Care Medicine

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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
Intensive Care Medicine ( IF 38.9 ) Pub Date : 2022-07-02 , DOI: 10.1007/s00134-022-06756-4
Chiara Robba _{1,

2} , Rafael Badenes _{3,

4} , Denise Battaglini _{1,

5} , Lorenzo Ball _{1,

2} , Iole Brunetti ₁ , Janus C Jakobsen _{6,

7} , Gisela Lilja ₈ , Hans Friberg ₉ , Pedro D Wendel-Garcia ₁₀ , Paul J Young _{11,

12,

13,

14} , Glenn Eastwood ₁₅ , Michelle S Chew ₁₆ , Johan Unden _{17,

18} , Matthew Thomas ₁₉ , Michael Joannidis ₂₀ , Alistair Nichol ₂₁ , Andreas Lundin ₂₂ , Jacob Hollenberg ₂₃ , Naomi Hammond ₂₄ , Manoj Saxena ₂₅ , Martin Annborn ₂₆ , Miroslav Solar _{27,

28} , Fabio S Taccone ₂₉ , Josef Dankiewicz ₃₀ , Niklas Nielsen ₃₁ , Paolo Pelosi _{1,

2} ,

Affiliation

Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Viale Benedetto XV 16, Genoa, Italy.
Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clínic Universitari de Valencia, Valencia, Spain.
Department of Surgery, University of Valencia, Valencia, Spain.
Department of Medicine, University of Barcelona, Barcelona, Spain.
Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
Department of Clinical Sciences Lund, Neurology, Skåne University Hospital, Lund University, Getingevägen 4, 222 41, Lund, Sweden.
Department of Clinical Sciences Lund, Anesthesia and Intensive Care, Lund University, Lund, Sweden.
Institute of Intensive Care Medicine, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242, New Zealand.
Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand.
Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Department of Critical Care, University of Melbourne, Parkville, VIC, Australia.
Department of Intensive Care, Austin Hospital, Melbourne, Australia.
Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
Department of Operation and Intensive Care, Lund University, Hallands Hospital Halmstad, Halland, Sweden.
University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria.
Monash University, Melbourne, VIC, Australia.
Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 423 45, Gothenburg, Sweden.
Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet, Södersjukhuset Sjukhusbacken 10, Solna, 118 83, Stockholm, Sweden.
Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia.
Intensive Care Unit, St George Hospital, Sydney, Australia.
Department of Clinical Medicine, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden.
Department of Internal Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic.
Department of Internal Medicine-Cardioangiology, University Hospital Hradec Králové, Hradec Králové, Czech Republic.
Department of Intensive Care Medicine, Université Libre de Bruxelles, Hopital Erasme, Brussels, Belgium.
Department of Clinical Sciences Lund, Cardiology, Skåne University Hospital, Lund University, Lund, Sweden.
Department of Clinical Sciences Lund, Anaesthesia and Intensive Care and Clinical Sciences Helsingborg, Helsingborg Hospital, Lund University, Lund, Sweden.

Purpose

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.

Methods

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.

Results

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_T) 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) cmH₂0, plateau pressure was 20 cmH₂0 (IQR = 17–23), driving pressure was 12 cmH₂0 (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.

Conclusions

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.

中文翻译：

最初 72 小时内的通气设置及其与院外心脏骤停患者结局的关联：院外心脏骤停 (TTM2) 试验后目标低温与目标常温的预先计划二次分析

目的

心脏骤停后患者的最佳通气设置及其与结果的关联仍不清楚。本研究的目的是描述在院外心脏骤停后患者机械通气的前 72 小时内应用的通气设置及其与 6 个月结局的关联。

方法

Target Temperature Management-2 试验的预先计划的子分析。临床结果是随机分组后 6 个月的死亡率和功能状态（通过改良 Rankin 量表评估）。

结果

共纳入 1848 名患者（平均年龄 64 [标准偏差，SD = 14] 岁）。6 个月时，950 名（51%）患者存活，898 名（49%）患者死亡。中位潮气量 ( VT ) 为 7（四分位距，IQR = _6.2–8.5 ) mL/预测体重 (PBW)，呼气末正压 (PEEP) 为 7 (IQR = 5–9) cmH ₂ 0，平台压为 20 cmH ₂ 0 (IQR = 17–23)，驱动压力为 12 cmH ₂0 (IQR = 10–15), 机械功率 16.2 J/min (IQR = 12.1–21.8), 通气比为 1.27 (IQR = 1.04–1.6), 呼吸频率为 17 次/分钟 (IQR = 14–20) . 中位氧分压为 87 mmHg (IQR = 75–105)，二氧化碳分压为 40.5 mmHg (IQR = 36–45.7)。呼吸频率、驱动压力和机械功率与 6 个月死亡率独立相关（其非线性轨迹的综合 p 值：分别为p < 0.0001、p = 0.026 和p = 0.029）。呼吸频率和驱动压力也与不良的神经系统预后独立相关（优势比，OR = 1.035，95% 置信区间，CI = 1.003–1.068，p = 0.030，OR = 1.005，95% CI = 1.001–1.036，p = 0.048）。计算为 [(4* 驱动压力) + 呼吸频率] 的复合公式与死亡率和不良神经系统预后独立相关。