Impact of Lung Compliance on Neurological Outcome in Patients with Acute Respiratory Distress Syndrome Following Out-of-Hospital Cardiac Arrest
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Routine Post-Cardiac Arrest Care Protocol
2.3. Definition of Variables
2.4. Statistical Analyses
3. Results
3.1. Baseline Characteristics
3.2. Mechanical Ventilator Parameters on Admission and Neurologic Outcome
3.3. Compliance and Good Neurologic Outcome
3.4. Differences of Day-1 Compliance for Neurologic Outcome
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Characteristics | Total (n = 119) | Poor Outcome (n = 96) | Good Outcome (n = 23) | p-Value |
---|---|---|---|---|
Age | 67.0 (57.0–78.0) | 69.0 (61.0–77.0) | 62.0 (52.0–80.5) | 0.770 |
Male | 76 (63.9) | 59 (61.5) | 17 (73.9) | 0.264 |
BMI (kg/m2) | 23.7 (21.1–26.1) | 22.9 (20.8–26.0) | 23.3 (18.9–26.2) | 0.719 |
Smoker | 44 (37.0) | 33 (34.4) | 11 (47.8) | 0.235 |
Past history | ||||
Previous ACS | 21 (17.6) | 16 (16.7) | 5 (21.7) | 0.567 |
Previous PCI | 15 (12.6) | 11 (11.5) | 4 (17.4) | 0.441 |
Hypertension | 58 (48.7) | 50 (52.1) | 8 (34.8) | 0.136 |
Diabetes mellitus | 44 (37.0) | 38 (39.6) | 6 (26.1) | 0.228 |
COPD | 12 (10.1%) | 12 (12.5) | 0 (0.0) | 0.075 |
CKD | 23 (19.3) | 20 (20.8) | 3 (13.0) | 0.560 |
Malignancy | 14 (11.8) | 12 (12.5) | 2 (8.7) | 0.599 |
Characteristics of Cardiac arrest | ||||
Witnessed arrest | 83 (69.7) | 65 (67.7) | 18 (78.3) | 0.324 |
Bystander CPR | 78 (65.5) | 63 (65.6) | 15 (65.2) | 0.814 |
Shockable rhythm | 22 (23.2) | 13 (16.0) | 9 (64.3) | <0.001 |
Cardiac caused | 51 (42.9) | 36 (37.5) | 15 (65.2) | 0.016 |
Time of CA to resuscitation (min) | 5.0 (0.0–9.0) | 5.0 (0.0–9.0) | 4.0 (0.0–6.5) | 0.708 |
Total CPR time (min) | 29.0 (15.0–41.0) | 31.5 (21.3–43.8) | 11.0 (4.0–21.0) | <0.001 |
ARDS risk factors | ||||
Shock | 69 (58.0) | 62 (64.6) | 7 (30.4) | 0.003 |
Aspiration | 62 (52.1) | 51 (53.1) | 11 (47.8) | 0.648 |
Pancreatitis | 3 (2.5) | 3 (3.1) | 0 (0.0) | 0.253 |
Pneumonia | 44 (37.0) | 36 (37.5) | 8 (34.8) | 0.808 |
Pulmonary contusion | 85 (71.4) | 69 (71.9) | 16 (69.6) | 0.827 |
Sepsis, no pneumonia | 19 (16.0) | 16 (16.7) | 3 (13.0) | 0.664 |
Sedative and NMB during TTM | ||||
Midazolam | 26 (21.8) | 22 (22.9) | 4 (17.4) | 0.565 |
Ketamine | 2 (1.7) | 2 (2.1) | 0 (0.0) | 0.352 |
Morphine | 38 (31.9) | 31 (32.3) | 7 (30.4) | 0.863 |
Propofol | 80 (67.2) | 59 (61.5) | 21 (91.3) | 0.003 |
Fentanyl | 58 (48.7) | 45 (46.9) | 13 (56.5) | 0.405 |
Continuous NMB | 54 (45.4) | 42 (43.8) | 12 (52.2) | 0.467 |
ICU care factors | ||||
BT, before TTM applied (°C) | 35.9 (35.1–36.5) | 35.8 (35.0–36.5) | 35.8 (35.2–36.2) | 0.521 |
Lactate, after ROSC (mmol/L) | 12.7 (9.4–15.0) | 13.2 (10.1–15.0) | 9.3 (6.4–13.0) | 0.002 |
Acquired pneumonia | 12 (10.1) | 7 (7.3) | 5 (21.7) | 0.040 |
Acquired UTI | 2 (1.7) | 2 (2.1) | 0 (0.0) | 0.485 |
SOFA at admission | 12.0 (11.0–15.0) | 12.0 (11.0–15.0) | 11.5 (10.5–15.0) | 0.654 |
MV duration (day) | 7.0 (3.0–9.0) | 7.0 (2.0–9.0) | 7.0 (5.0–13.0) | 0.050 |
Parameters | Total (n = 119) | Poor Outcome (n = 96) | Good Outcome (n = 23) | p-Value |
---|---|---|---|---|
pH | 7.0 (6.9–7.2) | 7.0 (6.8–7.2) | 7.2 (7.0–7.3) | 0.001 |
FiO2 (%) | 100.0 (80.0–100.0) | 100.0 (90.0–100.0) | 100.0 (60.0–100.0) | 0.028 |
PaO2 (mmHg) | 86.0 (68.4–115.8) | 86.0 (70.4–115.8) | 77.1 (62.5–137.4) | 0.287 |
PaCO2 (mmHg) | 54.0 (40.0–73.0) | 57.0 (43.5–76.0) | 46.0 (32.6–60.5) | 0.005 |
PEEP (cm H2O) | 5.0 (4.0–8.0) | 5.0 (4.0–8.0) | 5.0 (4.0–7.0) | 0.638 |
Inspiratory pressure (cm H2O) | 15.0 (12.0–18.0) | 16.0 (14.0–18.0) | 12.0 (12.0–13.5) | <0.001 |
Pplat (cm H2O) | 21.0 (17.3–25.8) | 21.0 (18.0–22.0) | 17.0 (16.0–20.0) | <0.001 |
Respiratory rate | 20.0 (18.0–22.0) | 20.0 (18.0–22.0) | 18.0 (15.0–20.0) | 0.013 |
Tidal volume (mL) | 427.0 (367.0–497.0) | 420.0 (360.0–489.5) | 458.0 (395.5–545.0) | 0.053 |
Compliance (ml/cm H2O) | 29.7 (21.8–36.9) | 27.5 (21.6–34.0) | 38.6 (33.1–46.2) | <0.001 |
Minute ventilation (L/min) | 8.2 (7.6–10.4) | 8.8 (7.7–10.3) | 8.8 (6.5–10.7) | 0.609 |
Variables | Univariate | Multivariate | ||||
---|---|---|---|---|---|---|
HR | 95% CI | p-Value | Adjusted HR | 95% CI | p-Value | |
Shockable | 1.47 | 1.22–1.77 | <0.001 | 1.28 | 1.01–1.63 | 0.039 |
Cardiac cause | 2.10 | 0.92–4.82 | 0.080 | 1.99 | 0.55–7.23 | 0.293 |
Carbon dioxide | 0.97 | 0.94–0.99 | 0.017 | 0.99 | 0.96–1.02 | 0.643 |
CPR duration | 0.96 | 0.93–1.00 | 0.060 | 0.94 | 0.90–1.00 | 0.038 |
Compliance | ||||||
Maximum | 1.03 | 1.01–1.05 | <0.001 | 1.05 | 1.02–1.09 | <0.001 |
Minimum | 1.04 | 1.02–1.06 | <0.001 | 1.08 | 1.03–1.13 | <0.001 |
Median | 1.04 | 1.02–1.06 | <0.001 | 1.06 | 1.02–1.09 | <0.001 |
Sensitivity | Specificity | PLR | NLR | PPV | NPV | |
---|---|---|---|---|---|---|
D1 max >32.5 | 69.5 | 72.0 | 2.48 | 0.42 | 90.4 | 38.3 |
D1 min >28.6 | 64.9 | 66.7 | 1.95 | 0.53 | 88.4 | 32.7 |
D1 median >31.4 | 59.3 | 66.7 | 1.78 | 0.61 | 90.0 | 24.5 |
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Kim, J.-s.; Kim, Y.-J.; Kim, M.; Ryoo, S.M.; Sohn, C.H.; Ahn, S.; Kim, W.Y. Impact of Lung Compliance on Neurological Outcome in Patients with Acute Respiratory Distress Syndrome Following Out-of-Hospital Cardiac Arrest. J. Clin. Med. 2020, 9, 527. https://doi.org/10.3390/jcm9020527
Kim J-s, Kim Y-J, Kim M, Ryoo SM, Sohn CH, Ahn S, Kim WY. Impact of Lung Compliance on Neurological Outcome in Patients with Acute Respiratory Distress Syndrome Following Out-of-Hospital Cardiac Arrest. Journal of Clinical Medicine. 2020; 9(2):527. https://doi.org/10.3390/jcm9020527
Chicago/Turabian StyleKim, June-sung, Youn-Jung Kim, Muyeol Kim, Seung Mok Ryoo, Chang Hwan Sohn, Shin Ahn, and Won Young Kim. 2020. "Impact of Lung Compliance on Neurological Outcome in Patients with Acute Respiratory Distress Syndrome Following Out-of-Hospital Cardiac Arrest" Journal of Clinical Medicine 9, no. 2: 527. https://doi.org/10.3390/jcm9020527