Ten rules for optimizing ventilatory settings and targets in post-cardiac arrest patients

Critical Care

Review

Denise Battaglini¹  Chiara Robba²  Paolo Pelosi² 

[1] Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy;Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy;Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy;

关键词: Cardiac arrest;    Mechanical ventilation;    Lung-protective ventilation;    Mechanical power;    Brain injury;   

DOI  :  10.1186/s13054-022-04268-7

 received in 2022-10-22, accepted in 2022-12-07,  发布年份 2022

来源: Springer

【 摘 要 】

Cardiac arrest (CA) is a major cause of morbidity and mortality frequently associated with neurological and systemic involvement. Supportive therapeutic strategies such as mechanical ventilation, hemodynamic settings, and temperature management have been implemented in the last decade in post-CA patients, aiming at protecting both the brain and the lungs and preventing systemic complications. A lung-protective ventilator strategy is currently the standard of care among critically ill patients since it demonstrated beneficial effects on mortality, ventilator-free days, and other clinical outcomes. The role of protective and personalized mechanical ventilation setting in patients without acute respiratory distress syndrome and after CA is becoming more evident. The individual effect of different parameters of lung-protective ventilation, including mechanical power as well as the optimal oxygen and carbon dioxide targets, on clinical outcomes is a matter of debate in post-CA patients. The management of hemodynamics and temperature in post-CA patients represents critical steps for obtaining clinical improvement. The aim of this review is to summarize and discuss current evidence on how to optimize mechanical ventilation in post-CA patients. We will provide ten tips and key insights to apply a lung-protective ventilator strategy in post-CA patients, considering the interplay between the lungs and other systems and organs, including the brain.

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

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