Matthew B A Harmon1, David M P van Meenen2, Annelou L I P van der Veen2, Jan M Binnekade2, Josef Dankiewicz3, Florian Ebner4, Niklas Nielsen4, Paolo Pelosi5, Marcus J Schultz6, Janneke Horn1, Hans Friberg3, Nicole P Juffermans7. 1. Department of Intensive Care, Academic Medical Centre, Amsterdam, The Netherlands; Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam, The Netherlands. 2. Department of Intensive Care, Academic Medical Centre, Amsterdam, The Netherlands. 3. Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Getingevägen, 22185, Lund, Sweden. 4. Department of Clinical Sciences, Lund University, Getingevägen, 22185, Lund, Sweden; Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden. 5. Department of Surgical Sciences and Integrated Diagnostics, Ospedale Policlinico San Martino, IRCCS per l'Oncologia - University of Genoa, Genoa, Italy. 6. Department of Intensive Care, Academic Medical Centre, Amsterdam, The Netherlands; Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam, The Netherlands; Mahidol Oxford Research Unit, Bangkok, Thailand. 7. Department of Intensive Care, Academic Medical Centre, Amsterdam, The Netherlands; Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam, The Netherlands. Electronic address: n.p.juffermans@amc.uva.nl.
Abstract
AIMS: Mechanical ventilation practices in patients with cardiac arrest are not well described. Also, the effect of temperature on mechanical ventilation settings is not known. The aims of this study were 1) to describe practice of mechanical ventilation and its relation with outcome 2) to determine effects of different target temperatures strategies (33 °C versus 36 °C) on mechanical ventilation settings. METHODS: This is a substudy of the TTM-trial in which unconscious survivors of a cardiac arrest due to a cardiac cause were randomized to two TTM strategies, 33 °C (TTM33) and 36 °C (TTM36). Mechanical ventilation data were obtained at three time points: 1) before TTM; 2) at the end of TTM (before rewarming) and 3) after rewarming. Logistic regression was used to determine an association between mechanical ventilation variables and outcome. Repeated-measures mixed modelling was performed to determine the effect of TTM on ventilation settings. RESULTS:Mechanical ventilation data was available for 567 of the 950 TTM patients. Of these, 81% was male with a mean (SD) age of 64 (12) years. At the end of TTM median tidal volume was 7.7 ml/kg predicted body weight (PBW)(6.4-8.7) and 60% of patients were ventilated with a tidal volume ≤ 8 ml/kg PBW. Median PEEP was 7.7cmH2O (6.4-8.7) and mean driving pressure was 14.6 cmH2O (±4.3). The median FiO2 fraction was 0.35 (0.30-0.45). Multivariate analysis showed an independent relationship between increased respiratory rate and 28-day mortality. TTM33 resulted in lower end-tidal CO2 (Pgroup = 0.0003) and higher alveolar dead space fraction (Pgroup = 0.003) compared to TTM36, while PCO2 levels and respiratory minute volume were similar between groups. CONCLUSIONS: In the majority of the cardiac arrest patients, protective ventilation settings are applied, including low tidal volumes and driving pressures. High respiratory rate was associated with mortality. TTM33 results in lower end-tidal CO2 levels and a higher alveolar dead space fraction compared to TTTM36.
RCT Entities:
AIMS: Mechanical ventilation practices in patients with cardiac arrest are not well described. Also, the effect of temperature on mechanical ventilation settings is not known. The aims of this study were 1) to describe practice of mechanical ventilation and its relation with outcome 2) to determine effects of different target temperatures strategies (33 °C versus 36 °C) on mechanical ventilation settings. METHODS: This is a substudy of the TTM-trial in which unconscious survivors of a cardiac arrest due to a cardiac cause were randomized to two TTM strategies, 33 °C (TTM33) and 36 °C (TTM36). Mechanical ventilation data were obtained at three time points: 1) before TTM; 2) at the end of TTM (before rewarming) and 3) after rewarming. Logistic regression was used to determine an association between mechanical ventilation variables and outcome. Repeated-measures mixed modelling was performed to determine the effect of TTM on ventilation settings. RESULTS: Mechanical ventilation data was available for 567 of the 950 TTM patients. Of these, 81% was male with a mean (SD) age of 64 (12) years. At the end of TTM median tidal volume was 7.7 ml/kg predicted body weight (PBW)(6.4-8.7) and 60% of patients were ventilated with a tidal volume ≤ 8 ml/kg PBW. Median PEEP was 7.7cmH2O (6.4-8.7) and mean driving pressure was 14.6 cmH2O (±4.3). The median FiO2 fraction was 0.35 (0.30-0.45). Multivariate analysis showed an independent relationship between increased respiratory rate and 28-day mortality. TTM33 resulted in lower end-tidal CO2 (Pgroup = 0.0003) and higher alveolar dead space fraction (Pgroup = 0.003) compared to TTM36, while PCO2 levels and respiratory minute volume were similar between groups. CONCLUSIONS: In the majority of the cardiac arrestpatients, protective ventilation settings are applied, including low tidal volumes and driving pressures. High respiratory rate was associated with mortality. TTM33 results in lower end-tidal CO2 levels and a higher alveolar dead space fraction compared to TTTM36.
Authors: Chiara Robba; Niklas Nielsen; Josef Dankiewicz; Rafael Badenes; Denise Battaglini; Lorenzo Ball; Iole Brunetti; Wendel-Garcia Pedro David; Paul Young; Glenn Eastwood; Michelle S Chew; Janus Jakobsen; Johan Unden; Matthew Thomas; Michael Joannidis; Alistair Nichol; Andreas Lundin; Jacob Hollenberg; Gisela Lilja; Naomi E Hammond; Manoj Saxena; Annborn Martin; Miroslav Solar; Fabio Silvio Taccone; Hans A Friberg; Paolo Pelosi Journal: BMJ Open Date: 2022-03-03 Impact factor: 2.692
Authors: Niklas Nielsen; Paolo Pelosi; Chiara Robba; Rafael Badenes; Denise Battaglini; Lorenzo Ball; Iole Brunetti; Janus C Jakobsen; Gisela Lilja; Hans Friberg; Pedro D Wendel-Garcia; Paul J Young; Glenn Eastwood; Michelle S Chew; Johan Unden; Matthew Thomas; Michael Joannidis; Alistair Nichol; Andreas Lundin; Jacob Hollenberg; Naomi Hammond; Manoj Saxena; Martin Annborn; Miroslav Solar; Fabio S Taccone; Josef Dankiewicz Journal: Intensive Care Med Date: 2022-07-02 Impact factor: 41.787