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Management and outcome of mechanically ventilated patients after cardiac arrest

Identifieur interne : 002B64 ( Main/Exploration ); précédent : 002B63; suivant : 002B65

Management and outcome of mechanically ventilated patients after cardiac arrest

Auteurs : Yuda Sutherasan [Thaïlande, Italie] ; Oscar Pe Uelas [Espagne] ; Alfonso Muriel [Espagne] ; Maria Vargas [Italie] ; Fernando Frutos-Vivar [Espagne] ; Iole Brunetti [Italie] ; Konstantinos Raymondos [Allemagne] ; Davide D Ntini [Italie] ; Niklas Nielsen [Suède] ; Niall D. Ferguson [Canada] ; Bernd W. Böttiger [Allemagne] ; Arnaud W. Thille [France] ; Andrew R. Davies [Australie] ; Javier Hurtado [Uruguay] ; Fernando Rios ; Carlos Apezteguía ; Damian A. Violi [Argentine] ; Nahit Cakar [Turquie] ; Marco González [Colombie] ; Bin Du [République populaire de Chine] ; Michael A. Kuiper [Pays-Bas] ; Marco Antonio Soares [Brésil] ; Younsuck Koh [Corée du Sud] ; Rui P. Moreno [Portugal] ; Pravin Amin [Inde] ; Vinko Tomicic [Chili] ; Luis Soto [Chili] ; Hans-Henrik Bülow [Danemark] ; Antonio Anzueto [États-Unis] ; Andrés Esteban [Espagne] ; Paolo Pelosi [Italie]

Source :

RBID : PMC:4457998

Descripteurs français

English descriptors

Abstract

Introduction

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.

Electronic supplementary material

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


Url:
DOI: 10.1186/s13054-015-0922-9
PubMed: 25953483
PubMed Central: 4457998


Affiliations:


Links toward previous steps (curation, corpus...)


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<name sortKey="Raymondos, Konstantinos" sort="Raymondos, Konstantinos" uniqKey="Raymondos K" first="Konstantinos" last="Raymondos">Konstantinos Raymondos</name>
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<name sortKey="Thille, Arnaud W" sort="Thille, Arnaud W" uniqKey="Thille A" first="Arnaud W" last="Thille">Arnaud W. Thille</name>
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<name sortKey="Davies, Andrew R" sort="Davies, Andrew R" uniqKey="Davies A" first="Andrew R" last="Davies">Andrew R. Davies</name>
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<nlm:aff id="Aff13">Department of Epidemiology and Preventive Medicine, ANZIC-RC, Monash University, Commercial Road, Melbourne, 3004 Australia</nlm:aff>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>Department of Epidemiology and Preventive Medicine, ANZIC-RC, Monash University, Commercial Road, Melbourne</wicri:regionArea>
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<settlement type="city">Melbourne</settlement>
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<name sortKey="Hurtado, Javier" sort="Hurtado, Javier" uniqKey="Hurtado J" first="Javier" last="Hurtado">Javier Hurtado</name>
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<nlm:aff id="Aff14">Dept. Pathophysiology, Hospital de Clínicas, Av. Italia s/n. Universidad de la Republica, Montevideo, 11600 Uruguay</nlm:aff>
<country xml:lang="fr">Uruguay</country>
<wicri:regionArea>Dept. Pathophysiology, Hospital de Clínicas, Av. Italia s/n. Universidad de la Republica, Montevideo</wicri:regionArea>
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<name sortKey="Rios, Fernando" sort="Rios, Fernando" uniqKey="Rios F" first="Fernando" last="Rios">Fernando Rios</name>
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<name sortKey="Apezteguia, Carlos" sort="Apezteguia, Carlos" uniqKey="Apezteguia C" first="Carlos" last="Apezteguía">Carlos Apezteguía</name>
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<nlm:aff id="Aff15">Department of Intensive Care, Hospital Nacional Prof. Alejandro Posadas El Palomar, Buenos Aires, CP 1684 Argentina</nlm:aff>
<wicri:noCountry code="subfield">CP 1684 Argentina</wicri:noCountry>
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<name sortKey="Violi, Damian A" sort="Violi, Damian A" uniqKey="Violi D" first="Damian A" last="Violi">Damian A. Violi</name>
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<name sortKey="Cakar, Nahit" sort="Cakar, Nahit" uniqKey="Cakar N" first="Nahit" last="Cakar">Nahit Cakar</name>
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<nlm:aff id="Aff17">Anesthesiology and Intensive Care, Istanbul University, Istanbul Medical Faculty, Millet cad., 34093 Istanbul, Turkey</nlm:aff>
<country xml:lang="fr">Turquie</country>
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<name sortKey="Gonzalez, Marco" sort="Gonzalez, Marco" uniqKey="Gonzalez M" first="Marco" last="González">Marco González</name>
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<nlm:aff id="Aff18">Clínica Medellín & Universidad Pontificia Bolivariana, Medellín, Colombia</nlm:aff>
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<wicri:regionArea>Clínica Medellín & Universidad Pontificia Bolivariana, Medellín</wicri:regionArea>
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<name sortKey="Du, Bin" sort="Du, Bin" uniqKey="Du B" first="Bin" last="Du">Bin Du</name>
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<nlm:aff id="Aff19">Medical ICU, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730 People’s Republic of China</nlm:aff>
<country xml:lang="fr">République populaire de Chine</country>
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<settlement type="city">Pékin</settlement>
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<author>
<name sortKey="Kuiper, Michael A" sort="Kuiper, Michael A" uniqKey="Kuiper M" first="Michael A" last="Kuiper">Michael A. Kuiper</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff20">Department of Intensive Care, Medical Center Leeuwarden Henri Dunantweg 2, 8934 AD Leeuwarden, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Department of Intensive Care, Medical Center Leeuwarden Henri Dunantweg 2, 8934 AD Leeuwarden</wicri:regionArea>
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<name sortKey="Soares, Marco Antonio" sort="Soares, Marco Antonio" uniqKey="Soares M" first="Marco Antonio" last="Soares">Marco Antonio Soares</name>
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<nlm:aff id="Aff21">Hospital Universitário São José, Belo Horizonte, Brazil</nlm:aff>
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<wicri:regionArea>Hospital Universitário São José, Belo Horizonte</wicri:regionArea>
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<settlement type="city">Belo Horizonte</settlement>
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</affiliation>
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<name sortKey="Koh, Younsuck" sort="Koh, Younsuck" uniqKey="Koh Y" first="Younsuck" last="Koh">Younsuck Koh</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff22">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</nlm:aff>
<country xml:lang="fr">Corée du Sud</country>
<wicri:regionArea>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</wicri:regionArea>
<placeName>
<settlement type="city">Séoul</settlement>
<region type="capital">Région capitale de Séoul</region>
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<name sortKey="Moreno, Rui P" sort="Moreno, Rui P" uniqKey="Moreno R" first="Rui P" last="Moreno">Rui P. Moreno</name>
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<nlm:aff id="Aff23">Unidade de Cuidados Intensivos Neurocríticos Hospital de São José Centro Hospitalarde Lisboa Central, E.P.E. R. José António Serrano, 1150-199 Lisbon, Portugal</nlm:aff>
<country xml:lang="fr">Portugal</country>
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<author>
<name sortKey="Amin, Pravin" sort="Amin, Pravin" uniqKey="Amin P" first="Pravin" last="Amin">Pravin Amin</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff24">Bombay Hospital Institute of Medical Sciences, 12 New Marine Lines, Mumbai, 400020 India</nlm:aff>
<country xml:lang="fr">Inde</country>
<wicri:regionArea>Bombay Hospital Institute of Medical Sciences, 12 New Marine Lines, Mumbai</wicri:regionArea>
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<author>
<name sortKey="Tomicic, Vinko" sort="Tomicic, Vinko" uniqKey="Tomicic V" first="Vinko" last="Tomicic">Vinko Tomicic</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff25">Clínica Las Lilas de Santiago, Santiago, Chile</nlm:aff>
<country xml:lang="fr">Chili</country>
<wicri:regionArea>Clínica Las Lilas de Santiago, Santiago</wicri:regionArea>
<wicri:noRegion>Santiago</wicri:noRegion>
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<author>
<name sortKey="Soto, Luis" sort="Soto, Luis" uniqKey="Soto L" first="Luis" last="Soto">Luis Soto</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff26">Instituto Nacional del Tórax de Santiago, Santiago, Chile</nlm:aff>
<country xml:lang="fr">Chili</country>
<wicri:regionArea>Instituto Nacional del Tórax de Santiago, Santiago</wicri:regionArea>
<wicri:noRegion>Santiago</wicri:noRegion>
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<author>
<name sortKey="Bulow, Hans Henrik" sort="Bulow, Hans Henrik" uniqKey="Bulow H" first="Hans-Henrik" last="Bülow">Hans-Henrik Bülow</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff27">Anaesthesiology and Intensive Care, Holbaek Hospitall, Region Zealand University of Copenhagen, Smedelundsgade, 60 4300 Holbaek, Denmark</nlm:aff>
<country xml:lang="fr">Danemark</country>
<wicri:regionArea>Anaesthesiology and Intensive Care, Holbaek Hospitall, Region Zealand University of Copenhagen, Smedelundsgade, 60 4300 Holbaek</wicri:regionArea>
<wicri:noRegion>60 4300 Holbaek</wicri:noRegion>
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</author>
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<name sortKey="Anzueto, Antonio" sort="Anzueto, Antonio" uniqKey="Anzueto A" first="Antonio" last="Anzueto">Antonio Anzueto</name>
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<nlm:aff id="Aff28">South Texas Veterans Health Care System and University of Texas Health Science Center, 111 E 7400 Merton Minter blvd, 78229 San Antonio, TX USA</nlm:aff>
<country>États-Unis</country>
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<region type="state">Texas</region>
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<wicri:cityArea>South Texas Veterans Health Care System and University of Texas Health Science Center, 111 E 7400 Merton Minter blvd, 78229 San Antonio</wicri:cityArea>
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<author>
<name sortKey="Esteban, Andres" sort="Esteban, Andres" uniqKey="Esteban A" first="Andrés" last="Esteban">Andrés Esteban</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff6">Hospital Universitario de Getafe and CIBER Enfermedades Respiratorias, Carretera de Toledo Km 12.500, 28905 Madrid, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Hospital Universitario de Getafe and CIBER Enfermedades Respiratorias, Carretera de Toledo Km 12.500, 28905 Madrid</wicri:regionArea>
<placeName>
<settlement type="city">Madrid</settlement>
<region nuts="2" type="region">Communauté de Madrid</region>
</placeName>
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</author>
<author>
<name sortKey="Pelosi, Paolo" sort="Pelosi, Paolo" uniqKey="Pelosi P" first="Paolo" last="Pelosi">Paolo Pelosi</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff2">Department of Surgical Sciences and Integrated Diagnostics IRCCS AOU San Martino-IST, Largo Rosanna Benzi 8, Genoa, 16131 Italy</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Department of Surgical Sciences and Integrated Diagnostics IRCCS AOU San Martino-IST, Largo Rosanna Benzi 8, Genoa</wicri:regionArea>
<wicri:noRegion>Genoa</wicri:noRegion>
</affiliation>
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<idno type="pmc">4457998</idno>
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<idno type="RBID">PMC:4457998</idno>
<idno type="doi">10.1186/s13054-015-0922-9</idno>
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<title xml:lang="en" level="a" type="main">Management and outcome of mechanically ventilated patients after cardiac arrest</title>
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<name sortKey="Sutherasan, Yuda" sort="Sutherasan, Yuda" uniqKey="Sutherasan Y" first="Yuda" last="Sutherasan">Yuda Sutherasan</name>
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<nlm:aff id="Aff1">Department of Medicine, Ramathibodi Hospital, Mahidol University, RAMA VI road, Bangkok, 10400 Thailand</nlm:aff>
<country xml:lang="fr">Thaïlande</country>
<wicri:regionArea>Department of Medicine, Ramathibodi Hospital, Mahidol University, RAMA VI road, Bangkok</wicri:regionArea>
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</affiliation>
<affiliation wicri:level="1">
<nlm:aff id="Aff2">Department of Surgical Sciences and Integrated Diagnostics IRCCS AOU San Martino-IST, Largo Rosanna Benzi 8, Genoa, 16131 Italy</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Department of Surgical Sciences and Integrated Diagnostics IRCCS AOU San Martino-IST, Largo Rosanna Benzi 8, Genoa</wicri:regionArea>
<wicri:noRegion>Genoa</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Pe Uelas, Oscar" sort="Pe Uelas, Oscar" uniqKey="Pe Uelas O" first="Oscar" last="Pe Uelas">Oscar Pe Uelas</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff3">Hospital Universitario Infanta Cristina and CIBER Enfermedades Respiratorias, Avenida 9 de junio, 2, 28981 Parla Madrid, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Hospital Universitario Infanta Cristina and CIBER Enfermedades Respiratorias, Avenida 9 de junio, 2, 28981 Parla Madrid</wicri:regionArea>
<wicri:noRegion>28981 Parla Madrid</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Muriel, Alfonso" sort="Muriel, Alfonso" uniqKey="Muriel A" first="Alfonso" last="Muriel">Alfonso Muriel</name>
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<nlm:aff id="Aff4">Biostatistics Unit, Ramón y Cajal Institute and Research Health, IRYCIS, CIBERESP, Hospital Ramón y Cajal Ctra., Colmenar Km 9.100, 28034 Madrid, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Biostatistics Unit, Ramón y Cajal Institute and Research Health, IRYCIS, CIBERESP, Hospital Ramón y Cajal Ctra., Colmenar Km 9.100, 28034 Madrid</wicri:regionArea>
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<settlement type="city">Madrid</settlement>
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</affiliation>
</author>
<author>
<name sortKey="Vargas, Maria" sort="Vargas, Maria" uniqKey="Vargas M" first="Maria" last="Vargas">Maria Vargas</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff5">Department of Neurosciences, Odonthostomatological and Reproductive Sciences, University of Naples, “Federico II”, Naples, 80100 Italy</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Department of Neurosciences, Odonthostomatological and Reproductive Sciences, University of Naples, “Federico II”, Naples</wicri:regionArea>
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</author>
<author>
<name sortKey="Frutos Vivar, Fernando" sort="Frutos Vivar, Fernando" uniqKey="Frutos Vivar F" first="Fernando" last="Frutos-Vivar">Fernando Frutos-Vivar</name>
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<nlm:aff id="Aff6">Hospital Universitario de Getafe and CIBER Enfermedades Respiratorias, Carretera de Toledo Km 12.500, 28905 Madrid, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Hospital Universitario de Getafe and CIBER Enfermedades Respiratorias, Carretera de Toledo Km 12.500, 28905 Madrid</wicri:regionArea>
<placeName>
<settlement type="city">Madrid</settlement>
<region nuts="2" type="region">Communauté de Madrid</region>
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</affiliation>
</author>
<author>
<name sortKey="Brunetti, Iole" sort="Brunetti, Iole" uniqKey="Brunetti I" first="Iole" last="Brunetti">Iole Brunetti</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff2">Department of Surgical Sciences and Integrated Diagnostics IRCCS AOU San Martino-IST, Largo Rosanna Benzi 8, Genoa, 16131 Italy</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Department of Surgical Sciences and Integrated Diagnostics IRCCS AOU San Martino-IST, Largo Rosanna Benzi 8, Genoa</wicri:regionArea>
<wicri:noRegion>Genoa</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Raymondos, Konstantinos" sort="Raymondos, Konstantinos" uniqKey="Raymondos K" first="Konstantinos" last="Raymondos">Konstantinos Raymondos</name>
<affiliation wicri:level="3">
<nlm:aff id="Aff7">Anaesthesiology and Intensive Care Medicine, Medical School Hanover, 544 Carl-Neuberg-Strasse 1, D-30625 Hanover, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea>Anaesthesiology and Intensive Care Medicine, Medical School Hanover, 544 Carl-Neuberg-Strasse 1, D-30625 Hanover</wicri:regionArea>
<placeName>
<region type="land" nuts="2">Basse-Saxe</region>
<settlement type="city">Hanovre</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="D Ntini, Davide" sort="D Ntini, Davide" uniqKey="D Ntini D" first="Davide" last="D Ntini">Davide D Ntini</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff8">Dipartimento di Anestesia, Rianimazione e Terapia Intensiva, Universita’ degli Studi di Foggia, Viale Pinto, 1, 71100 Foggia, Italy</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Dipartimento di Anestesia, Rianimazione e Terapia Intensiva, Universita’ degli Studi di Foggia, Viale Pinto, 1, 71100 Foggia</wicri:regionArea>
<wicri:noRegion>71100 Foggia</wicri:noRegion>
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</author>
<author>
<name sortKey="Nielsen, Niklas" sort="Nielsen, Niklas" uniqKey="Nielsen N" first="Niklas" last="Nielsen">Niklas Nielsen</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff9">Department of Anesthesia and Intensive Care, Intensive Care Unit, Helsingborg Hospital, S Vallgatan 5, 251 87 Helsingborg, Sweden</nlm:aff>
<country xml:lang="fr">Suède</country>
<wicri:regionArea>Department of Anesthesia and Intensive Care, Intensive Care Unit, Helsingborg Hospital, S Vallgatan 5, 251 87 Helsingborg</wicri:regionArea>
<wicri:noRegion>251 87 Helsingborg</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Ferguson, Niall D" sort="Ferguson, Niall D" uniqKey="Ferguson N" first="Niall D" last="Ferguson">Niall D. Ferguson</name>
<affiliation wicri:level="4">
<nlm:aff id="Aff10">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</nlm:aff>
<orgName type="university">Université de Toronto</orgName>
<country>Canada</country>
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<settlement type="city">Toronto</settlement>
<region type="state">Ontario</region>
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</affiliation>
</author>
<author>
<name sortKey="Bottiger, Bernd W" sort="Bottiger, Bernd W" uniqKey="Bottiger B" first="Bernd W" last="Böttiger">Bernd W. Böttiger</name>
<affiliation wicri:level="3">
<nlm:aff id="Aff11">Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937 Köln, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea>Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937 Köln</wicri:regionArea>
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<region type="land" nuts="1">Rhénanie-du-Nord-Westphalie</region>
<region type="district" nuts="2">District de Cologne</region>
<settlement type="city">Cologne</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Thille, Arnaud W" sort="Thille, Arnaud W" uniqKey="Thille A" first="Arnaud W" last="Thille">Arnaud W. Thille</name>
<affiliation wicri:level="3">
<nlm:aff id="Aff12">Cenre Hospitalier Universitaire de Poitiers, Réanimation Médicale, INSERM CIC 1402, Université de Poitiers, Poitiers, 86000 France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Cenre Hospitalier Universitaire de Poitiers, Réanimation Médicale, INSERM CIC 1402, Université de Poitiers, Poitiers</wicri:regionArea>
<placeName>
<region type="region">Nouvelle-Aquitaine</region>
<region type="old region">Poitou-Charentes</region>
<settlement type="city">Poitiers</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Davies, Andrew R" sort="Davies, Andrew R" uniqKey="Davies A" first="Andrew R" last="Davies">Andrew R. Davies</name>
<affiliation wicri:level="3">
<nlm:aff id="Aff13">Department of Epidemiology and Preventive Medicine, ANZIC-RC, Monash University, Commercial Road, Melbourne, 3004 Australia</nlm:aff>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>Department of Epidemiology and Preventive Medicine, ANZIC-RC, Monash University, Commercial Road, Melbourne</wicri:regionArea>
<placeName>
<settlement type="city">Melbourne</settlement>
<region type="état">Victoria (État)</region>
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</affiliation>
</author>
<author>
<name sortKey="Hurtado, Javier" sort="Hurtado, Javier" uniqKey="Hurtado J" first="Javier" last="Hurtado">Javier Hurtado</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff14">Dept. Pathophysiology, Hospital de Clínicas, Av. Italia s/n. Universidad de la Republica, Montevideo, 11600 Uruguay</nlm:aff>
<country xml:lang="fr">Uruguay</country>
<wicri:regionArea>Dept. Pathophysiology, Hospital de Clínicas, Av. Italia s/n. Universidad de la Republica, Montevideo</wicri:regionArea>
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</author>
<author>
<name sortKey="Rios, Fernando" sort="Rios, Fernando" uniqKey="Rios F" first="Fernando" last="Rios">Fernando Rios</name>
<affiliation>
<nlm:aff id="Aff15">Department of Intensive Care, Hospital Nacional Prof. Alejandro Posadas El Palomar, Buenos Aires, CP 1684 Argentina</nlm:aff>
<wicri:noCountry code="subfield">CP 1684 Argentina</wicri:noCountry>
</affiliation>
</author>
<author>
<name sortKey="Apezteguia, Carlos" sort="Apezteguia, Carlos" uniqKey="Apezteguia C" first="Carlos" last="Apezteguía">Carlos Apezteguía</name>
<affiliation>
<nlm:aff id="Aff15">Department of Intensive Care, Hospital Nacional Prof. Alejandro Posadas El Palomar, Buenos Aires, CP 1684 Argentina</nlm:aff>
<wicri:noCountry code="subfield">CP 1684 Argentina</wicri:noCountry>
</affiliation>
</author>
<author>
<name sortKey="Violi, Damian A" sort="Violi, Damian A" uniqKey="Violi D" first="Damian A" last="Violi">Damian A. Violi</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff16">Medical Staff-Critical Care, Hospital Prof. Dr. Luis Guemes, Buenos Aires, Argentina</nlm:aff>
<country xml:lang="fr">Argentine</country>
<wicri:regionArea>Medical Staff-Critical Care, Hospital Prof. Dr. Luis Guemes, Buenos Aires</wicri:regionArea>
<wicri:noRegion>Buenos Aires</wicri:noRegion>
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</author>
<author>
<name sortKey="Cakar, Nahit" sort="Cakar, Nahit" uniqKey="Cakar N" first="Nahit" last="Cakar">Nahit Cakar</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff17">Anesthesiology and Intensive Care, Istanbul University, Istanbul Medical Faculty, Millet cad., 34093 Istanbul, Turkey</nlm:aff>
<country xml:lang="fr">Turquie</country>
<wicri:regionArea>Anesthesiology and Intensive Care, Istanbul University, Istanbul Medical Faculty, Millet cad., 34093 Istanbul</wicri:regionArea>
<wicri:noRegion>34093 Istanbul</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Gonzalez, Marco" sort="Gonzalez, Marco" uniqKey="Gonzalez M" first="Marco" last="González">Marco González</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff18">Clínica Medellín & Universidad Pontificia Bolivariana, Medellín, Colombia</nlm:aff>
<country xml:lang="fr">Colombie</country>
<wicri:regionArea>Clínica Medellín & Universidad Pontificia Bolivariana, Medellín</wicri:regionArea>
<wicri:noRegion>Medellín</wicri:noRegion>
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</author>
<author>
<name sortKey="Du, Bin" sort="Du, Bin" uniqKey="Du B" first="Bin" last="Du">Bin Du</name>
<affiliation wicri:level="3">
<nlm:aff id="Aff19">Medical ICU, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730 People’s Republic of China</nlm:aff>
<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea>Medical ICU, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing</wicri:regionArea>
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<settlement type="city">Pékin</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Kuiper, Michael A" sort="Kuiper, Michael A" uniqKey="Kuiper M" first="Michael A" last="Kuiper">Michael A. Kuiper</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff20">Department of Intensive Care, Medical Center Leeuwarden Henri Dunantweg 2, 8934 AD Leeuwarden, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Department of Intensive Care, Medical Center Leeuwarden Henri Dunantweg 2, 8934 AD Leeuwarden</wicri:regionArea>
<wicri:noRegion>8934 AD Leeuwarden</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Soares, Marco Antonio" sort="Soares, Marco Antonio" uniqKey="Soares M" first="Marco Antonio" last="Soares">Marco Antonio Soares</name>
<affiliation wicri:level="3">
<nlm:aff id="Aff21">Hospital Universitário São José, Belo Horizonte, Brazil</nlm:aff>
<country xml:lang="fr">Brésil</country>
<wicri:regionArea>Hospital Universitário São José, Belo Horizonte</wicri:regionArea>
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<settlement type="city">Belo Horizonte</settlement>
<region type="state">Minas Gerais</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Koh, Younsuck" sort="Koh, Younsuck" uniqKey="Koh Y" first="Younsuck" last="Koh">Younsuck Koh</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff22">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</nlm:aff>
<country xml:lang="fr">Corée du Sud</country>
<wicri:regionArea>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</wicri:regionArea>
<placeName>
<settlement type="city">Séoul</settlement>
<region type="capital">Région capitale de Séoul</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Moreno, Rui P" sort="Moreno, Rui P" uniqKey="Moreno R" first="Rui P" last="Moreno">Rui P. Moreno</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff23">Unidade de Cuidados Intensivos Neurocríticos Hospital de São José Centro Hospitalarde Lisboa Central, E.P.E. R. José António Serrano, 1150-199 Lisbon, Portugal</nlm:aff>
<country xml:lang="fr">Portugal</country>
<wicri:regionArea>Unidade de Cuidados Intensivos Neurocríticos Hospital de São José Centro Hospitalarde Lisboa Central, E.P.E. R. José António Serrano, 1150-199 Lisbon</wicri:regionArea>
<wicri:noRegion>1150-199 Lisbon</wicri:noRegion>
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</author>
<author>
<name sortKey="Amin, Pravin" sort="Amin, Pravin" uniqKey="Amin P" first="Pravin" last="Amin">Pravin Amin</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff24">Bombay Hospital Institute of Medical Sciences, 12 New Marine Lines, Mumbai, 400020 India</nlm:aff>
<country xml:lang="fr">Inde</country>
<wicri:regionArea>Bombay Hospital Institute of Medical Sciences, 12 New Marine Lines, Mumbai</wicri:regionArea>
<wicri:noRegion>Mumbai</wicri:noRegion>
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</author>
<author>
<name sortKey="Tomicic, Vinko" sort="Tomicic, Vinko" uniqKey="Tomicic V" first="Vinko" last="Tomicic">Vinko Tomicic</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff25">Clínica Las Lilas de Santiago, Santiago, Chile</nlm:aff>
<country xml:lang="fr">Chili</country>
<wicri:regionArea>Clínica Las Lilas de Santiago, Santiago</wicri:regionArea>
<wicri:noRegion>Santiago</wicri:noRegion>
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</author>
<author>
<name sortKey="Soto, Luis" sort="Soto, Luis" uniqKey="Soto L" first="Luis" last="Soto">Luis Soto</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff26">Instituto Nacional del Tórax de Santiago, Santiago, Chile</nlm:aff>
<country xml:lang="fr">Chili</country>
<wicri:regionArea>Instituto Nacional del Tórax de Santiago, Santiago</wicri:regionArea>
<wicri:noRegion>Santiago</wicri:noRegion>
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</author>
<author>
<name sortKey="Bulow, Hans Henrik" sort="Bulow, Hans Henrik" uniqKey="Bulow H" first="Hans-Henrik" last="Bülow">Hans-Henrik Bülow</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff27">Anaesthesiology and Intensive Care, Holbaek Hospitall, Region Zealand University of Copenhagen, Smedelundsgade, 60 4300 Holbaek, Denmark</nlm:aff>
<country xml:lang="fr">Danemark</country>
<wicri:regionArea>Anaesthesiology and Intensive Care, Holbaek Hospitall, Region Zealand University of Copenhagen, Smedelundsgade, 60 4300 Holbaek</wicri:regionArea>
<wicri:noRegion>60 4300 Holbaek</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Anzueto, Antonio" sort="Anzueto, Antonio" uniqKey="Anzueto A" first="Antonio" last="Anzueto">Antonio Anzueto</name>
<affiliation wicri:level="2">
<nlm:aff id="Aff28">South Texas Veterans Health Care System and University of Texas Health Science Center, 111 E 7400 Merton Minter blvd, 78229 San Antonio, TX USA</nlm:aff>
<country>États-Unis</country>
<placeName>
<region type="state">Texas</region>
</placeName>
<wicri:cityArea>South Texas Veterans Health Care System and University of Texas Health Science Center, 111 E 7400 Merton Minter blvd, 78229 San Antonio</wicri:cityArea>
</affiliation>
</author>
<author>
<name sortKey="Esteban, Andres" sort="Esteban, Andres" uniqKey="Esteban A" first="Andrés" last="Esteban">Andrés Esteban</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff6">Hospital Universitario de Getafe and CIBER Enfermedades Respiratorias, Carretera de Toledo Km 12.500, 28905 Madrid, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Hospital Universitario de Getafe and CIBER Enfermedades Respiratorias, Carretera de Toledo Km 12.500, 28905 Madrid</wicri:regionArea>
<placeName>
<settlement type="city">Madrid</settlement>
<region nuts="2" type="region">Communauté de Madrid</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Pelosi, Paolo" sort="Pelosi, Paolo" uniqKey="Pelosi P" first="Paolo" last="Pelosi">Paolo Pelosi</name>
<affiliation wicri:level="1">
<nlm:aff id="Aff2">Department of Surgical Sciences and Integrated Diagnostics IRCCS AOU San Martino-IST, Largo Rosanna Benzi 8, Genoa, 16131 Italy</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Department of Surgical Sciences and Integrated Diagnostics IRCCS AOU San Martino-IST, Largo Rosanna Benzi 8, Genoa</wicri:regionArea>
<wicri:noRegion>Genoa</wicri:noRegion>
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<series>
<title level="j">Critical Care</title>
<idno type="ISSN">1364-8535</idno>
<idno type="eISSN">1466-609X</idno>
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<date when="2015">2015</date>
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<keywords scheme="KwdEn" xml:lang="en">
<term>Age Factors</term>
<term>Aged</term>
<term>Body Weight</term>
<term>Cardiovascular Diseases</term>
<term>Cohort Studies</term>
<term>Drug Utilization</term>
<term>Female</term>
<term>Heart Arrest (mortality)</term>
<term>Heart Arrest (therapy)</term>
<term>Hospital Mortality</term>
<term>Humans</term>
<term>Hypnotics and Sedatives (therapeutic use)</term>
<term>Intensive Care Units</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Multivariate Analysis</term>
<term>Pneumonia, Ventilator-Associated (epidemiology)</term>
<term>Positive-Pressure Respiration</term>
<term>Respiration, Artificial</term>
<term>Respiratory Distress Syndrome, Adult (epidemiology)</term>
<term>Tidal Volume</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr">
<term>Adulte d'âge moyen</term>
<term>Analyse multivariée</term>
<term>Arrêt cardiaque ()</term>
<term>Arrêt cardiaque (mortalité)</term>
<term>Facteurs de l'âge</term>
<term>Femelle</term>
<term>Humains</term>
<term>Hypnotiques et sédatifs (usage thérapeutique)</term>
<term>Maladies cardiovasculaires</term>
<term>Mortalité hospitalière</term>
<term>Mâle</term>
<term>Pneumopathie infectieuse sous ventilation assistée (épidémiologie)</term>
<term>Poids du corps</term>
<term>Sujet âgé</term>
<term>Syndrome de détresse respiratoire de l'adulte (épidémiologie)</term>
<term>Unités de soins intensifs</term>
<term>Utilisation médicament</term>
<term>Ventilation artificielle</term>
<term>Ventilation à pression positive</term>
<term>Volume courant</term>
<term>Études de cohortes</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en">
<term>Hypnotics and Sedatives</term>
</keywords>
<keywords scheme="MESH" qualifier="epidemiology" xml:lang="en">
<term>Pneumonia, Ventilator-Associated</term>
<term>Respiratory Distress Syndrome, Adult</term>
</keywords>
<keywords scheme="MESH" qualifier="mortality" xml:lang="en">
<term>Heart Arrest</term>
</keywords>
<keywords scheme="MESH" qualifier="mortalité" xml:lang="fr">
<term>Arrêt cardiaque</term>
</keywords>
<keywords scheme="MESH" qualifier="therapy" xml:lang="en">
<term>Heart Arrest</term>
</keywords>
<keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr">
<term>Hypnotiques et sédatifs</term>
</keywords>
<keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr">
<term>Pneumopathie infectieuse sous ventilation assistée</term>
<term>Syndrome de détresse respiratoire de l'adulte</term>
</keywords>
<keywords scheme="MESH" xml:lang="en">
<term>Age Factors</term>
<term>Aged</term>
<term>Body Weight</term>
<term>Cardiovascular Diseases</term>
<term>Cohort Studies</term>
<term>Drug Utilization</term>
<term>Female</term>
<term>Hospital Mortality</term>
<term>Humans</term>
<term>Intensive Care Units</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Multivariate Analysis</term>
<term>Positive-Pressure Respiration</term>
<term>Respiration, Artificial</term>
<term>Tidal Volume</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr">
<term>Adulte d'âge moyen</term>
<term>Analyse multivariée</term>
<term>Arrêt cardiaque</term>
<term>Facteurs de l'âge</term>
<term>Femelle</term>
<term>Humains</term>
<term>Maladies cardiovasculaires</term>
<term>Mortalité hospitalière</term>
<term>Mâle</term>
<term>Poids du corps</term>
<term>Sujet âgé</term>
<term>Unités de soins intensifs</term>
<term>Utilisation médicament</term>
<term>Ventilation artificielle</term>
<term>Ventilation à pression positive</term>
<term>Volume courant</term>
<term>Études de cohortes</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front>
<div type="abstract" xml:lang="en">
<sec>
<title>Introduction</title>
<p>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.</p>
</sec>
<sec>
<title>Methods</title>
<p>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.</p>
</sec>
<sec>
<title>Results</title>
<p>Among 812 patients, 100 were included from 1998, 239 from 2004 and 473 from 2010. Ventilatory management changed over time, with decreased tidal volumes (V
<sub>T</sub>
) (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);
<italic>P</italic>
<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, PaO
<sub>2</sub>
<60 mmHg, cardiovascular dysfunction and less use of sedative agents. Higher V
<sub>T</sub>
, and plateau pressure with lower PEEP were associated with occurrence of ARDS and pneumonia acquired during ICU stay.</p>
</sec>
<sec>
<title>Conclusions</title>
<p>Protective mechanical ventilation with lower V
<sub>T</sub>
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.</p>
</sec>
<sec>
<title>Electronic supplementary material</title>
<p>The online version of this article (doi:10.1186/s13054-015-0922-9) contains supplementary material, which is available to authorized users.</p>
</sec>
</div>
</front>
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<name sortKey="Metzger, A" uniqKey="Metzger A">A Metzger</name>
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<name sortKey="Pelosi, P" uniqKey="Pelosi P">P Pelosi</name>
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<name sortKey="Bensberg, R" uniqKey="Bensberg R">R Bensberg</name>
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<author>
<name sortKey="Dembinski, R" uniqKey="Dembinski R">R Dembinski</name>
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<author>
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</author>
<author>
<name sortKey="Chanques, G" uniqKey="Chanques G">G Chanques</name>
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<author>
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<author>
<name sortKey="Pelosi, P" uniqKey="Pelosi P">P Pelosi</name>
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<author>
<name sortKey="Hoehn, C" uniqKey="Hoehn C">C Hoehn</name>
</author>
<author>
<name sortKey="Meissner, C" uniqKey="Meissner C">C Meissner</name>
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<author>
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<name sortKey="Spieth, Pm" uniqKey="Spieth P">PM Spieth</name>
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<author>
<name sortKey="Beda, A" uniqKey="Beda A">A Beda</name>
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<author>
<name sortKey="Nowack, T" uniqKey="Nowack T">T Nowack</name>
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<author>
<name sortKey="Krause, A" uniqKey="Krause A">A Krause</name>
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<author>
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<author>
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<name sortKey="Putensen, C" uniqKey="Putensen C">C Putensen</name>
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<author>
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<li>Colombie</li>
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<li>France</li>
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<li>Italie</li>
<li>Pays-Bas</li>
<li>Portugal</li>
<li>République populaire de Chine</li>
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<li>Uruguay</li>
<li>États-Unis</li>
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<li>Basse-Saxe</li>
<li>Communauté de Madrid</li>
<li>District de Cologne</li>
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<li>Ontario</li>
<li>Poitou-Charentes</li>
<li>Rhénanie-du-Nord-Westphalie</li>
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<li>Texas</li>
<li>Victoria (État)</li>
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<li>Belo Horizonte</li>
<li>Cologne</li>
<li>Hanovre</li>
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<name sortKey="Du, Bin" sort="Du, Bin" uniqKey="Du B" first="Bin" last="Du">Bin Du</name>
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<name sortKey="Kuiper, Michael A" sort="Kuiper, Michael A" uniqKey="Kuiper M" first="Michael A" last="Kuiper">Michael A. Kuiper</name>
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<name sortKey="Soares, Marco Antonio" sort="Soares, Marco Antonio" uniqKey="Soares M" first="Marco Antonio" last="Soares">Marco Antonio Soares</name>
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<region name="Région capitale de Séoul">
<name sortKey="Koh, Younsuck" sort="Koh, Younsuck" uniqKey="Koh Y" first="Younsuck" last="Koh">Younsuck Koh</name>
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<name sortKey="Moreno, Rui P" sort="Moreno, Rui P" uniqKey="Moreno R" first="Rui P" last="Moreno">Rui P. Moreno</name>
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<name sortKey="Amin, Pravin" sort="Amin, Pravin" uniqKey="Amin P" first="Pravin" last="Amin">Pravin Amin</name>
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<country name="Chili">
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<name sortKey="Soto, Luis" sort="Soto, Luis" uniqKey="Soto L" first="Luis" last="Soto">Luis Soto</name>
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<country name="Danemark">
<noRegion>
<name sortKey="Bulow, Hans Henrik" sort="Bulow, Hans Henrik" uniqKey="Bulow H" first="Hans-Henrik" last="Bülow">Hans-Henrik Bülow</name>
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<country name="États-Unis">
<region name="Texas">
<name sortKey="Anzueto, Antonio" sort="Anzueto, Antonio" uniqKey="Anzueto A" first="Antonio" last="Anzueto">Antonio Anzueto</name>
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</record>

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