title: Ventilation and gas exchange management after cardiac arrest.
abstract: For several decades, physicians had integrated several interventions aiming to improve the outcomes in post-cardiac arrest patients. However, the mortality rate after cardiac arrest is still as high as 50%. Post-cardiac arrest syndrome is associated with high morbidity and mortality due to not only poor neurological outcome and cardiovascular failure but also respiratory dysfunction. To minimize ventilator-associated lung injury, protective mechanical ventilation by using low tidal volume ventilation and driving pressure may decrease pulmonary complications and improve survival. Low level of positive end-expiratory pressure (PEEP) can be initiated and titrated with careful cardiac output and respiratory mechanics monitoring. Furthermore, optimizing gas exchange by avoiding hypoxia and hyperoxia as well as maintaining normocarbia may improve neurological and survival outcome. Early multidisciplinary cardiac rehabilitation intervention is recommended. Minimally invasive monitoring techniques, that is, echocardiography, transpulmonary thermodilution method measuring extravascular lung water, as well as transcranial Doppler ultrasound, might be useful to improve appropriate management of post-cardiac arrest patients.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Ramathibodi Hospital, Mahidol University, 270 RAMA VI Road, Bangkok 10400, Thailand. Electronic address: sutherasan_yuda@yahoo.com.
authors.forename: Yuda
authors.initials: Y
authors.lastname: Sutherasan
authors.affiliation: Dipartimento di Anestesia, Rianimazione e Terapia Intensiva, Universita' degli Studi di Foggia, Viale Pinto, 1, Foggia 71100, Italy. Electronic address: prraimondo@iol.it.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Raimondo
authors.affiliation: Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino-IST, Largo Rosanna Benzi 8, Genoa 16131, Italy. Electronic address: ppelosi@hotmail.com.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pelosi
mesh_terms: D001784:Blood Gas Analysis / Q000379:methods; D006323:Heart Arrest / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D011175:Positive-Pressure Respiration / Q000379:methods*; D011659:Pulmonary Gas Exchange / Q000502:physiology*; D012123:Pulmonary Ventilation / Q000502:physiology*; D012121:Respiration, Artificial / Q000379:methods; D013990:Tidal Volume / Q000502:physiology
keywords: cardiac arrest; mechanical ventilation; mortality; pulmonary complications