title: Management and outcome of mechanically ventilated patients after cardiac arrest.
abstract: BACKGROUND
  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.
authors.affiliation: Department of Medicine, Ramathibodi Hospital, Mahidol University, RAMA VI road, Bangkok, 10400, Thailand. sutherasan_yuda@yahoo.com.|Department of Surgical Sciences and Integrated Diagnostics IRCCS AOU San Martino-IST, Largo Rosanna Benzi 8, Genoa, 16131, Italy. sutherasan_yuda@yahoo.com.
authors.forename: Yuda
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authors.lastname: Sutherasan
authors.affiliation: Hospital Universitario Infanta Cristina and CIBER Enfermedades Respiratorias, Avenida 9 de junio, 2, 28981, Parla, Madrid, Spain. openuelas@gmail.com.
authors.forename: Oscar
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authors.lastname: Peñuelas
authors.affiliation: Biostatistics Unit, Ramón y Cajal Institute and Research Health, IRYCIS, CIBERESP, Hospital Ramón y Cajal Ctra., Colmenar Km 9.100, 28034, Madrid, Spain. alfonso.muriel@hrc.es.
authors.forename: Alfonso
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authors.lastname: Muriel
authors.affiliation: Department of Neurosciences, Odonthostomatological and Reproductive Sciences, University of Naples, "Federico II", Naples, 80100, Italy. vargas.maria82@gmail.com.
authors.forename: Maria
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authors.lastname: Vargas
authors.affiliation: Hospital Universitario de Getafe and CIBER Enfermedades Respiratorias, Carretera de Toledo Km 12.500, 28905, Madrid, Spain. ffrutos@ucigetafe.com.
authors.forename: Fernando
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authors.lastname: Frutos-Vivar
authors.affiliation: Department of Surgical Sciences and Integrated Diagnostics IRCCS AOU San Martino-IST, Largo Rosanna Benzi 8, Genoa, 16131, Italy. ibrunetti@tin.it.
authors.forename: Iole
authors.initials: I
authors.lastname: Brunetti
authors.affiliation: Anaesthesiology and Intensive Care Medicine, Medical School Hanover, 544 Carl-Neuberg-Strasse 1, D-30625, Hanover, Germany. raymondos@ards.eu.
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authors.affiliation: Dipartimento di Anestesia, Rianimazione e Terapia Intensiva, Universita' degli Studi di Foggia, Viale Pinto, 1, 71100, Foggia, Italy. davide.dantini@hotmail.it.
authors.forename: Davide
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authors.affiliation: Department of Anesthesia and Intensive Care, Intensive Care Unit, Helsingborg Hospital, S Vallgatan 5, 251 87, Helsingborg, Sweden. niklas.nielsen@med.lu.se.
authors.forename: Niklas
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authors.affiliation: Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, University Health Network and Mount Sinai Hospital, 585 University Avenue, Toronto, M5G 2N2, ON, Canada. n.ferguson@utoronto.ca.
authors.forename: Niall D
authors.initials: ND
authors.lastname: Ferguson
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Köln, Germany. bernd.boettiger@uk-koeln.de.
authors.forename: Bernd W
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authors.forename: Arnaud W
authors.initials: AW
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authors.affiliation: Department of Epidemiology and Preventive Medicine, ANZIC-RC, Monash University, Commercial Road, Melbourne, 3004, Australia. andrew.davies@monash.edu.
authors.forename: Andrew R
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authors.affiliation: Dept. Pathophysiology, Hospital de Clínicas, Av. Italia s/n. Universidad de la Republica, Montevideo, 11600, Uruguay. jhurtado@hc.edu.uy.
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authors.affiliation: Department of Intensive Care, Hospital Nacional Prof. Alejandro Posadas El Palomar, Buenos Aires, CP, 1684, Argentina. fernandrios@gmail.com.
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authors.affiliation: Department of Intensive Care, Hospital Nacional Prof. Alejandro Posadas El Palomar, Buenos Aires, CP, 1684, Argentina. capez@intramed.net.
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authors.affiliation: Medical Staff-Critical Care, Hospital Prof. Dr. Luis Guemes, Buenos Aires, Argentina. damianalejandro.violi@gmail.com.
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authors.affiliation: Anesthesiology and Intensive Care, Istanbul University, Istanbul Medical Faculty, Millet cad., 34093, Istanbul, Turkey. cakarn@istanbul.edu.tr.
authors.forename: Nahit
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authors.affiliation: Department of Intensive Care, Medical Center Leeuwarden Henri Dunantweg 2, 8934, AD, Leeuwarden, The Netherlands. mi.kuiper@wxs.nl.
authors.forename: Michael A
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authors.forename: Marco Antonio
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authors.affiliation: Department of Pulmonary and Critical Care Medicine Asan Medical Center, Univ. of Ulsan College of Medicine, 388-1 Pungnap Dong Songpa Ku Seoul, 138-736, Seoul, Republic of Korea. yskoh@amc.seoul.kr.
authors.forename: Younsuck
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authors.forename: Rui P
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authors.forename: Pravin
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authors.affiliation: Clínica Las Lilas de Santiago, Santiago, Chile. vtomicic@alemana.cl.
authors.forename: Vinko
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authors.forename: Luis
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authors.affiliation: Anaesthesiology and Intensive Care, Holbaek Hospitall, Region Zealand University of Copenhagen, Smedelundsgade, 60 4300, Holbaek, Denmark. hhbulow@dadlnet.dk.
authors.forename: Hans-Henrik
authors.initials: HH
authors.lastname: Bülow
authors.affiliation: South Texas Veterans Health Care System and University of Texas Health Science Center, 111 E 7400 Merton Minter blvd, 78229, San Antonio, TX, USA. anzueto@uthscsa.edu.
authors.forename: Antonio
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authors.lastname: Anzueto
authors.affiliation: Hospital Universitario de Getafe and CIBER Enfermedades Respiratorias, Carretera de Toledo Km 12.500, 28905, Madrid, Spain. aesteban@ucigetafe.com.
authors.forename: Andrés
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authors.lastname: Esteban
authors.affiliation: Department of Surgical Sciences and Integrated Diagnostics IRCCS AOU San Martino-IST, Largo Rosanna Benzi 8, Genoa, 16131, Italy. ppelosi@hotmail.com.
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mesh_terms: D000367:Age Factors; D000368:Aged; D001835:Body Weight; D002318:Cardiovascular Diseases; D015331:Cohort Studies; D004363:Drug Utilization; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology; D011175:Positive-Pressure Respiration; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000453:epidemiology; D013990:Tidal Volume
chemical_list: D006993:Hypnotics and Sedatives