The importance of ventilator settings and respiratory mechanics in patients resuscitated from cardiac arrest

Excerpt

Among mechanically ventilated patients admitted to an intensive care unit after an out-of-hospital cardiac arrest (OHCA), less than 40% will survive to hospital discharge [1]. This high mortality rate is in part attributable to the multi-organ dysfunction caused by post-reperfusion syndrome [2]. Up to 50% of patients successfully resuscitated from cardiac arrest develop lung injury, fulfilling acute respiratory distress syndrome (ARDS) criteria during the stay in the intensive care unit (ICU) [3]. Lung injury occurs because of the systemic inflammation caused by the post-reperfusion syndrome and as a direct consequence of chest compression-induced lung damage [4]. In ARDS patients, limiting tidal volumes (V_T), plateau and driving pressure (ΔP) represents the mainstay of respiratory support management, with the aim of reducing ventilator-induced lung injury (VILI) [5, 6]. In mechanically ventilated patients, VILI is caused by excessive stress and strain in the aerated lung, the volume of which is markedly reduced by alveolar flooding, edema and inflammation. This releases cytokines (biotrauma) that lead to multi-organ dysfunction, the most frequent cause of death in patients with ARDS [7]. …