Ventilatory settings in the initial 72 h and their association with outcome in out-of-hospital cardiac arrest patients: a preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial

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; Niklas Nielsen; Paolo Pelosi; TTM2 Trial collaborators

doi:10.1007/s00134-022-06756-4

Ventilatory settings in the initial 72 h and their association with outcome in out-of-hospital cardiac arrest patients: a preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial

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 SaxenaMartin Annborn, Miroslav Solar, Fabio S. Taccone, Josef Dankiewicz, Niklas Nielsen, Paolo Pelosi, TTM2 Trial collaborators

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

36 Citations (Scopus)

20 Downloads (Pure)

Abstract

Purpose: The optimal ventilatory settings in patients after cardiac arrest and their association with outcome remain unclear. The aim of this study was to describe the ventilatory settings applied in the first 72 h of mechanical ventilation in patients after out-of-hospital cardiac arrest and their association with 6-month outcomes. Methods: Preplanned sub-analysis of the Target Temperature Management-2 trial. Clinical outcomes were mortality and functional status (assessed by the Modified Rankin Scale) 6 months after randomization. Results: A total of 1848 patients were included (mean age 64 [Standard Deviation, SD = 14] years). At 6 months, 950 (51%) patients were alive and 898 (49%) were dead. Median tidal volume (V_T) was 7 (Interquartile range, IQR = 6.2–8.5) mL per Predicted Body Weight (PBW), positive end expiratory pressure (PEEP) was 7 (IQR = 5–9) cmH₂0, plateau pressure was 20 cmH₂0 (IQR = 17–23), driving pressure was 12 cmH₂0 (IQR = 10–15), mechanical power 16.2 J/min (IQR = 12.1–21.8), ventilatory ratio was 1.27 (IQR = 1.04–1.6), and respiratory rate was 17 breaths/minute (IQR = 14–20). Median partial pressure of oxygen was 87 mmHg (IQR = 75–105), and partial pressure of carbon dioxide was 40.5 mmHg (IQR = 36–45.7). Respiratory rate, driving pressure, and mechanical power were independently associated with 6-month mortality (omnibus p-values for their non-linear trajectories: p < 0.0001, p = 0.026, and p = 0.029, respectively). Respiratory rate and driving pressure were also independently associated with poor neurological outcome (odds ratio, OR = 1.035, 95% confidence interval, CI = 1.003–1.068, p = 0.030, and OR = 1.005, 95% CI = 1.001–1.036, p = 0.048). A composite formula calculated as [(4*driving pressure) + respiratory rate] was independently associated with mortality and poor neurological outcome. Conclusions: Protective ventilation strategies are commonly applied in patients after cardiac arrest. Ventilator settings in the first 72 h after hospital admission, in particular driving pressure and respiratory rate, may influence 6-month outcomes.

Original language	English
Pages (from-to)	1024-1038
Number of pages	15
Journal	Intensive Care Medicine
Volume	48
Issue number	8
DOIs	https://doi.org/10.1007/s00134-022-06756-4
Publication status	Published - Aug 2022
Externally published	Yes

Bibliographical note

Copyright the Author(s) 2022. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

Cardiac arrest
Driving pressure
Mechanical power
Mechanical ventilation
Outcome
Ventilator settings

Access to Document

10.1007/s00134-022-06756-4Licence: CC BY-NC

Publisher version (open access)Final published version, 1.34 MBLicence: CC BY-NC

Fingerprint

Dive into the research topics of 'Ventilatory settings in the initial 72 h and their association with outcome in out-of-hospital cardiac arrest patients: a preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial'. Together they form a unique fingerprint.

Cite this

Robba, C., Badenes, R., Battaglini, D., Ball, L., Brunetti, I., Jakobsen, J. C., Lilja, G., Friberg, H., Wendel-Garcia, P. D., Young, P. J., Eastwood, G., Chew, M. S., Unden, J., Thomas, M., Joannidis, M., Nichol, A., Lundin, A., Hollenberg, J., Hammond, N., ... TTM2 Trial collaborators (2022). Ventilatory settings in the initial 72 h and their association with outcome in out-of-hospital cardiac arrest patients: a preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial. Intensive Care Medicine, 48(8), 1024-1038. https://doi.org/10.1007/s00134-022-06756-4

Robba, Chiara ; Badenes, Rafael ; Battaglini, Denise et al. / Ventilatory settings in the initial 72 h and their association with outcome in out-of-hospital cardiac arrest patients : a preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial. In: Intensive Care Medicine. 2022 ; Vol. 48, No. 8. pp. 1024-1038.

@article{1378bfa63de7430ab427a90129e22a3d,

title = "Ventilatory settings in the initial 72 h and their association with outcome in out-of-hospital cardiac arrest patients: a preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial",

abstract = "Purpose: The optimal ventilatory settings in patients after cardiac arrest and their association with outcome remain unclear. The aim of this study was to describe the ventilatory settings applied in the first 72 h of mechanical ventilation in patients after out-of-hospital cardiac arrest and their association with 6-month outcomes. Methods: Preplanned sub-analysis of the Target Temperature Management-2 trial. Clinical outcomes were mortality and functional status (assessed by the Modified Rankin Scale) 6 months after randomization. Results: A total of 1848 patients were included (mean age 64 [Standard Deviation, SD = 14] years). At 6 months, 950 (51%) patients were alive and 898 (49%) were dead. Median tidal volume (VT) was 7 (Interquartile range, IQR = 6.2–8.5) mL per Predicted Body Weight (PBW), positive end expiratory pressure (PEEP) was 7 (IQR = 5–9) cmH20, plateau pressure was 20 cmH20 (IQR = 17–23), driving pressure was 12 cmH20 (IQR = 10–15), mechanical power 16.2 J/min (IQR = 12.1–21.8), ventilatory ratio was 1.27 (IQR = 1.04–1.6), and respiratory rate was 17 breaths/minute (IQR = 14–20). Median partial pressure of oxygen was 87 mmHg (IQR = 75–105), and partial pressure of carbon dioxide was 40.5 mmHg (IQR = 36–45.7). Respiratory rate, driving pressure, and mechanical power were independently associated with 6-month mortality (omnibus p-values for their non-linear trajectories: p < 0.0001, p = 0.026, and p = 0.029, respectively). Respiratory rate and driving pressure were also independently associated with poor neurological outcome (odds ratio, OR = 1.035, 95% confidence interval, CI = 1.003–1.068, p = 0.030, and OR = 1.005, 95% CI = 1.001–1.036, p = 0.048). A composite formula calculated as [(4*driving pressure) + respiratory rate] was independently associated with mortality and poor neurological outcome. Conclusions: Protective ventilation strategies are commonly applied in patients after cardiac arrest. Ventilator settings in the first 72 h after hospital admission, in particular driving pressure and respiratory rate, may influence 6-month outcomes.",

keywords = "Cardiac arrest, Driving pressure, Mechanical power, Mechanical ventilation, Outcome, Ventilator settings",

author = "Chiara Robba and Rafael Badenes and Denise Battaglini and Lorenzo Ball and Iole Brunetti and Jakobsen, {Janus C.} and Gisela Lilja and Hans Friberg and Wendel-Garcia, {Pedro D.} and Young, {Paul J.} and Glenn Eastwood and Chew, {Michelle S.} and Johan Unden and Matthew Thomas and Michael Joannidis and Alistair Nichol and Andreas Lundin and Jacob Hollenberg and Naomi Hammond and Manoj Saxena and Martin Annborn and Miroslav Solar and Taccone, {Fabio S.} and Josef Dankiewicz and Niklas Nielsen and Paolo Pelosi and {TTM2 Trial collaborators} and Jan Belohl{\'a}vek and Clifton Callaway and Alain Cariou and Tobias Cronberg and David Erlinge and Jan Hovdenes and Hans Kirkegaard and Helena Levin and Morgan, {Matt P. G.} and Per Nordberg and Mauro Oddo and Christian Rylander and Christian Storm and Susann Ull{\'e}n and Wise, {Matt P.} and Kathy Rowan and David Harrison and Paul Mouncey and Manu Shankar-Hari and Duncan Young and Theis Lange and Karolina Palm{\'e}r and Karlsson, {Ulla Britt} and Simon Heissler and Frances Bass and John Myburgh and Colman Taylor and Adele Bellino and Marwa Abel-all and Ben Finfer and Carolyn Koch and Yang Li and Anne O'Connor and Julia Pilowsky and Tina Schneider and Anna Tippett and Bridget Ady and Tessa Broadley and Amanda Brown and Liz Melgaard and Mimi Morgan and Vanessa Singh and Rebecca Symons and Kathrin Becker and {Van Sante}, Nathalie and Vendula Saleova and Silvie Zerzanova and Samia Sefir-Kribel and Ute L{\"u}beck and Martina Carrara and Kathryn Fernando and Diane Mackle and Leanlove Navarra and Judith Riley and Elin Westerheim and Marianne Flateb{\o} and Ameldina Ceric and Zana Haxhija and Lovisa Terling and Lena Bossmar and Liz Jergle and M{\aa}nsson, {Hel{\'e}n Holm} and Maillard, {Samia Abed} and Zagar, {Andreja Vujicic} and Christina Jodlauk and Helen Hill and Jennifer Scrivens and Kate Ainscough and Ciara Fahey and Rinaldo Bellomo and Leah Peck and Helen Young and Winston Cheung and Rosalba Cross and Michael Hayes and Nitin Jain and Mark Kol and Asim Shah and Atul Wagh and Helen Wong and Martinez, {F. Eduardo} and Gail Brinkerhoff and Dustin Bush and Antony Stewart and Anders Aneman and Lien Lombardo and Peter McCanny and James Penketh and Ian Seppelt",

note = "Copyright the Author(s) 2022. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",

year = "2022",

month = aug,

doi = "10.1007/s00134-022-06756-4",

language = "English",

volume = "48",

pages = "1024--1038",

journal = "Intensive Care Medicine",

issn = "0342-4642",

publisher = "Springer-VDI-Verlag GmbH & Co. KG",

number = "8",

}

Robba, C, Badenes, R, Battaglini, D, Ball, L, Brunetti, I, Jakobsen, JC, Lilja, G, Friberg, H, Wendel-Garcia, PD, Young, PJ, Eastwood, G, Chew, MS, Unden, J, Thomas, M, Joannidis, M, Nichol, A, Lundin, A, Hollenberg, J, Hammond, N, Saxena, M, Annborn, M, Solar, M, Taccone, FS, Dankiewicz, J, Nielsen, N, Pelosi, P & TTM2 Trial collaborators 2022, 'Ventilatory settings in the initial 72 h and their association with outcome in out-of-hospital cardiac arrest patients: a preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial', Intensive Care Medicine, vol. 48, no. 8, pp. 1024-1038. https://doi.org/10.1007/s00134-022-06756-4

Ventilatory settings in the initial 72 h and their association with outcome in out-of-hospital cardiac arrest patients: a preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial. / Robba, Chiara; Badenes, Rafael; Battaglini, Denise et al.
In: Intensive Care Medicine, Vol. 48, No. 8, 08.2022, p. 1024-1038.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Ventilatory settings in the initial 72 h and their association with outcome in out-of-hospital cardiac arrest patients

T2 - a preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial

AU - Robba, Chiara

AU - Badenes, Rafael

AU - Battaglini, Denise

AU - Ball, Lorenzo

AU - Brunetti, Iole

AU - Jakobsen, Janus C.

AU - Lilja, Gisela

AU - Friberg, Hans

AU - Wendel-Garcia, Pedro D.

AU - Young, Paul J.

AU - Eastwood, Glenn

AU - Chew, Michelle S.

AU - Unden, Johan

AU - Thomas, Matthew

AU - Joannidis, Michael

AU - Nichol, Alistair

AU - Lundin, Andreas

AU - Hollenberg, Jacob

AU - Hammond, Naomi

AU - Saxena, Manoj

AU - Annborn, Martin

AU - Solar, Miroslav

AU - Taccone, Fabio S.

AU - Dankiewicz, Josef

AU - Nielsen, Niklas

AU - Pelosi, Paolo

AU - TTM2 Trial collaborators

AU - Belohlávek, Jan

AU - Callaway, Clifton

AU - Cariou, Alain

AU - Cronberg, Tobias

AU - Erlinge, David

AU - Hovdenes, Jan

AU - Kirkegaard, Hans

AU - Levin, Helena

AU - Morgan, Matt P. G.

AU - Nordberg, Per

AU - Oddo, Mauro

AU - Rylander, Christian

AU - Storm, Christian

AU - Ullén, Susann

AU - Wise, Matt P.

AU - Rowan, Kathy

AU - Harrison, David

AU - Mouncey, Paul

AU - Shankar-Hari, Manu

AU - Young, Duncan

AU - Lange, Theis

AU - Palmér, Karolina

AU - Karlsson, Ulla Britt

AU - Heissler, Simon

AU - Bass, Frances

AU - Myburgh, John

AU - Taylor, Colman

AU - Bellino, Adele

AU - Abel-all, Marwa

AU - Finfer, Ben

AU - Koch, Carolyn

AU - Li, Yang

AU - O'Connor, Anne

AU - Pilowsky, Julia

AU - Schneider, Tina

AU - Tippett, Anna

AU - Ady, Bridget

AU - Broadley, Tessa

AU - Brown, Amanda

AU - Melgaard, Liz

AU - Morgan, Mimi

AU - Singh, Vanessa

AU - Symons, Rebecca

AU - Becker, Kathrin

AU - Van Sante, Nathalie

AU - Saleova, Vendula

AU - Zerzanova, Silvie

AU - Sefir-Kribel, Samia

AU - Lübeck, Ute

AU - Carrara, Martina

AU - Fernando, Kathryn

AU - Mackle, Diane

AU - Navarra, Leanlove

AU - Riley, Judith

AU - Westerheim, Elin

AU - Flatebø, Marianne

AU - Ceric, Ameldina

AU - Haxhija, Zana

AU - Terling, Lovisa

AU - Bossmar, Lena

AU - Jergle, Liz

AU - Månsson, Helén Holm

AU - Maillard, Samia Abed

AU - Zagar, Andreja Vujicic

AU - Jodlauk, Christina

AU - Hill, Helen

AU - Scrivens, Jennifer

AU - Ainscough, Kate

AU - Fahey, Ciara

AU - Bellomo, Rinaldo

AU - Peck, Leah

AU - Young, Helen

AU - Cheung, Winston

AU - Cross, Rosalba

AU - Hayes, Michael

AU - Jain, Nitin

AU - Kol, Mark

AU - Shah, Asim

AU - Wagh, Atul

AU - Wong, Helen

AU - Martinez, F. Eduardo

AU - Brinkerhoff, Gail

AU - Bush, Dustin

AU - Stewart, Antony

AU - Aneman, Anders

AU - Lombardo, Lien

AU - McCanny, Peter

AU - Penketh, James

AU - Seppelt, Ian

N1 - Copyright the Author(s) 2022. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2022/8

Y1 - 2022/8

N2 - Purpose: The optimal ventilatory settings in patients after cardiac arrest and their association with outcome remain unclear. The aim of this study was to describe the ventilatory settings applied in the first 72 h of mechanical ventilation in patients after out-of-hospital cardiac arrest and their association with 6-month outcomes. Methods: Preplanned sub-analysis of the Target Temperature Management-2 trial. Clinical outcomes were mortality and functional status (assessed by the Modified Rankin Scale) 6 months after randomization. Results: A total of 1848 patients were included (mean age 64 [Standard Deviation, SD = 14] years). At 6 months, 950 (51%) patients were alive and 898 (49%) were dead. Median tidal volume (VT) was 7 (Interquartile range, IQR = 6.2–8.5) mL per Predicted Body Weight (PBW), positive end expiratory pressure (PEEP) was 7 (IQR = 5–9) cmH20, plateau pressure was 20 cmH20 (IQR = 17–23), driving pressure was 12 cmH20 (IQR = 10–15), mechanical power 16.2 J/min (IQR = 12.1–21.8), ventilatory ratio was 1.27 (IQR = 1.04–1.6), and respiratory rate was 17 breaths/minute (IQR = 14–20). Median partial pressure of oxygen was 87 mmHg (IQR = 75–105), and partial pressure of carbon dioxide was 40.5 mmHg (IQR = 36–45.7). Respiratory rate, driving pressure, and mechanical power were independently associated with 6-month mortality (omnibus p-values for their non-linear trajectories: p < 0.0001, p = 0.026, and p = 0.029, respectively). Respiratory rate and driving pressure were also independently associated with poor neurological outcome (odds ratio, OR = 1.035, 95% confidence interval, CI = 1.003–1.068, p = 0.030, and OR = 1.005, 95% CI = 1.001–1.036, p = 0.048). A composite formula calculated as [(4*driving pressure) + respiratory rate] was independently associated with mortality and poor neurological outcome. Conclusions: Protective ventilation strategies are commonly applied in patients after cardiac arrest. Ventilator settings in the first 72 h after hospital admission, in particular driving pressure and respiratory rate, may influence 6-month outcomes.

AB - Purpose: The optimal ventilatory settings in patients after cardiac arrest and their association with outcome remain unclear. The aim of this study was to describe the ventilatory settings applied in the first 72 h of mechanical ventilation in patients after out-of-hospital cardiac arrest and their association with 6-month outcomes. Methods: Preplanned sub-analysis of the Target Temperature Management-2 trial. Clinical outcomes were mortality and functional status (assessed by the Modified Rankin Scale) 6 months after randomization. Results: A total of 1848 patients were included (mean age 64 [Standard Deviation, SD = 14] years). At 6 months, 950 (51%) patients were alive and 898 (49%) were dead. Median tidal volume (VT) was 7 (Interquartile range, IQR = 6.2–8.5) mL per Predicted Body Weight (PBW), positive end expiratory pressure (PEEP) was 7 (IQR = 5–9) cmH20, plateau pressure was 20 cmH20 (IQR = 17–23), driving pressure was 12 cmH20 (IQR = 10–15), mechanical power 16.2 J/min (IQR = 12.1–21.8), ventilatory ratio was 1.27 (IQR = 1.04–1.6), and respiratory rate was 17 breaths/minute (IQR = 14–20). Median partial pressure of oxygen was 87 mmHg (IQR = 75–105), and partial pressure of carbon dioxide was 40.5 mmHg (IQR = 36–45.7). Respiratory rate, driving pressure, and mechanical power were independently associated with 6-month mortality (omnibus p-values for their non-linear trajectories: p < 0.0001, p = 0.026, and p = 0.029, respectively). Respiratory rate and driving pressure were also independently associated with poor neurological outcome (odds ratio, OR = 1.035, 95% confidence interval, CI = 1.003–1.068, p = 0.030, and OR = 1.005, 95% CI = 1.001–1.036, p = 0.048). A composite formula calculated as [(4*driving pressure) + respiratory rate] was independently associated with mortality and poor neurological outcome. Conclusions: Protective ventilation strategies are commonly applied in patients after cardiac arrest. Ventilator settings in the first 72 h after hospital admission, in particular driving pressure and respiratory rate, may influence 6-month outcomes.

KW - Cardiac arrest

KW - Driving pressure

KW - Mechanical power

KW - Mechanical ventilation

KW - Outcome

KW - Ventilator settings

UR - http://www.scopus.com/inward/record.url?scp=85133282899&partnerID=8YFLogxK

U2 - 10.1007/s00134-022-06756-4

DO - 10.1007/s00134-022-06756-4

M3 - Article

C2 - 35780195

AN - SCOPUS:85133282899

SN - 0342-4642

VL - 48

SP - 1024

EP - 1038

JO - Intensive Care Medicine

JF - Intensive Care Medicine

IS - 8

ER -

Robba C, Badenes R, Battaglini D, Ball L, Brunetti I, Jakobsen JC et al. Ventilatory settings in the initial 72 h and their association with outcome in out-of-hospital cardiac arrest patients: a preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial. Intensive Care Medicine. 2022 Aug;48(8):1024-1038. doi: 10.1007/s00134-022-06756-4