Favorable Neurocognitive Outcome with Low Tidal Volume Ventilation After Cardiac Arrest

 Original/ ATS Journals/ DOI: http://dx.doi.org/10.1164/rccm.201609-1771OC


 ----------

Favorable Neurocognitive Outcome with Low Tidal Volume Ventilation After Cardiac Arrest

----------

 

∎ Rationale: Neurocognitive outcome after out-of-hospital cardiac arrest (OHCA) often is poor even when initial resuscitation succeeds. Lower tidal volumes (VT) 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 following OHCA.

 

∎ Methods: Propensity adjusted analysis of two center retrospective cohort of OHCA patients 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 mL/kg predicted body weight (PBW). The primary endpoint was favorable neurocognitive outcome (cerebral performance category 1-2) at discharge.

 

∎ Measurements and Main Results: Of 256 included patients, 38% received time-weighted average VT > 8 mL/kg PBW during the first 48 hours. Lower VT was independently associated with favorable neurocognitive outcome in propensity-adjusted analysis (OR 1.61, 95% CI 1.13-2.28 per 1 mL/kg PBW decrease in VT; p=.008). This finding was robust to several sensitivity analyses. Lower VT also was associated with more ventilator-free days (ß = 1.78, 95% CI 0.39-3.16 per 1 mL/kg PBW decrease; p=.012) and shock-free days (ß = 1.31, 95% CI 0.10-2.51; p=.034). VT was not associated with hypercapnia (p=1.00). While the propensity score incorporated several biologically relevant covariates, only height, weight, and admitting hospital were independent predictors of VT ≤ 8 mL/kg PBW.

 

----------

∎∎∎ Conclusions:

 

»Lower VT following 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.

 

----------

http://www.atsjournals.org/doi/pdf/10.1164/rccm.201609-1771OC

Comments

Post a Comment

Thanks for your comments, will reply you soon!!!

Popular posts from this blog

How To Choose The Correct Size Of Suction Catheter

Image
  How To Choose The Correct Size Of Suction Catheter Dr. Prashant Kumar Background: Suctioning of the artificial airway is a common procedure in everyday clinical practice. 1. Indication: Need to suction a tracheal/ tracheostomy tube should be assessed frequently as necessary by anyone providing care to the patient. The frequency of assessment may be as frequent as continuous in patients with very high secretions to as low as once in several days in dry-clean airways. No generalization can be made on this point.      The decision to suction a tracheal tube must be made on the basis of the clinical need to maintain the patency of the tracheobronchial tree. No routine suctioning should be performed based on timing alone. A tracheal tube should only be suctioned when clinically indicated by signs which could include:   i. visible, palpable or audible secretions (such as sputum, gastric or upper airway contents or blood)   ii. respiratory: desaturation, rising peak inspirat
Read more

How often do you test Vitamin D levels and does it matter in your ICU?

Image
How often do you test Vitamin D levels and does it matter in your ICU?     Vitamin D is essentially needed in general population and the critically ill. This vitamin has significant role in maintaining immune function, cardiovascular state, glucose control and mucosal barrier function etc.     70 to 100 % have vitamin D deficiency in the ICU.   Vitamin D supplementation is safe in general population and ICU patients. Hypervitaminosis D should be avoided through correct replacement regimen.   Normal desirable levels: Labs report Vitamin D3 levels in two different units; ng/mL & nmol/L   1 ng/mL = 2.5 nmol/L   Normal value 30-100 ng/mL (75 to 250 nmol/L) Anything over 100 ng/ml (250 nmol/l) for a prolonged period may be harmful. Dietary supplement upto 4,000 IU or less per day is considered safe.   Supplements comparisons and dose schedules   Oral Orally administered Vitamin D3 partially gets metabolized by the hepatic 25- hydroxylase enzyme a
Read more

Midline catheter- basilic vein cannulation: in difficult peripheral venous access

Image
            The Case A 47 year old M was admitted with COVID-19 disease. His constitution is obese with very difficult peripheral venous access. Central venous access is fraught with air embolism in a respiratory distress patient and is considered to accompany more complications.   *Midline catheters* How it is inserted   Generally the basilic or cephalic veins are too deep to be visualized superficially. Therefore, ultrasound is used to place the cannula.   This required skill and practice. -==-     Dr. Prashant Kumar
Read more