Format

Send to

Choose Destination
Am J Respir Crit Care Med. 2017 May 1;195(9):1198-1206. doi: 10.1164/rccm.201609-1771OC.

Favorable Neurocognitive Outcome with Low Tidal Volume Ventilation after Cardiac Arrest.

Author information

1
1 Division of Pulmonary and Critical Care Medicine and.
2
2 Department of Medicine, University of California, San Diego, San Diego, California; and.
3
3 Department of Anesthesia and Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Abstract

RATIONALE:

Neurocognitive outcome after out-of-hospital cardiac arrest (OHCA) is often poor, even when initial resuscitation succeeds. Lower tidal volumes (Vts) attenuate extrapulmonary organ injury in other disease states and are neuroprotective in preclinical models of critical illness.

OBJECTIVE:

To evaluate the association between Vt and neurocognitive outcome after OHCA.

METHODS:

We performed a propensity-adjusted analysis of a two-center retrospective cohort of patients experiencing OHCA who received mechanical ventilation for at least the first 48 hours of hospitalization. Vt was calculated as the time-weighted average over the first 48 hours, in milliliters per kilogram of predicted body weight (PBW). The primary endpoint was favorable neurocognitive outcome (cerebral performance category of 1 or 2) at discharge.

MEASUREMENTS AND MAIN RESULTS:

Of 256 included patients, 38% received time-weighted average Vt greater than 8 ml/kg PBW during the first 48 hours. Lower Vt was independently associated with favorable neurocognitive outcome in propensity-adjusted analysis (odds ratio, 1.61; 95% confidence interval [CI], 1.13-2.28 per 1-ml/kg PBW decrease in Vt; P = 0.008). This finding was robust to several sensitivity analyses. Lower Vt also was associated with more ventilator-free days (β = 1.78; 95% CI, 0.39-3.16 per 1-ml/kg PBW decrease; P = 0.012) and shock-free days (β = 1.31; 95% CI, 0.10-2.51; P = 0.034). Vt was not associated with hypercapnia (P = 1.00). Although the propensity score incorporated several biologically relevant covariates, only height, weight, and admitting hospital were independent predictors of Vt less than or equal to 8 ml/kg PBW.

CONCLUSIONS:

Lower Vt after OHCA is independently associated with favorable neurocognitive outcome, more ventilator-free days, and more shock-free days. These findings suggest a role for low-Vt ventilation after cardiac arrest.

KEYWORDS:

acute lung injury; cardiac arrest; cerebral ischemia; out-of-hospital cardiac arrest; ventilator-induced lung injury

Comment in

PMID:
28267376
PMCID:
PMC5439016
DOI:
10.1164/rccm.201609-1771OC
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Atypon Icon for PubMed Central
Loading ...
Support Center