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Critical Care

, 19:215

First Online: 08 May 2015Received: 04 February 2015Accepted: 13 April 2015


IntroductionThe 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.

MethodsWe 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.

ResultsAmong 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.

ConclusionsProtective 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.

AbbreviationsABWActual body weight

ARDSAcute respiratory distress syndrome

pHaArterial pH

GCSGlasgow Coma Score

ICUIntensive care unit

PBWPredicted body weight

PEEPPositive end-expiratory pressure

PRVCPressure regulated volume control

PSVPressure support ventilation

ROSCReturn of spontaneous circulation

SAPSSimplified acute physiology score

SOFASequential organ failure assessment score

SDstandard deviation

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-015-0922-9 contains supplementary material, which is available to authorized users.

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Autor: Yuda Sutherasan - Oscar Peñuelas - Alfonso Muriel - Maria Vargas - Fernando Frutos-Vivar - Iole Brunetti - Konstantinos Ra


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