Acid Base Disorder, Cardiac Arrest (CA), Cardiogenic Shock, Mechanical Ventilation
Conditions
Brief summary
This study aims to better understand how mechanical ventilation settings affect patients admitted to the coronary care unit after cardiac arrest or with cardiogenic shock. These patients often require mechanical ventilation, but current guidelines provide limited evidence on the best approach. Improper ventilation settings can lead to acid-base imbalances, such as respiratory acidosis or alkalosis, which may worsen patient outcomes. The retrospective analysis will include 100 adult patients (50 post-cardiac arrest and 50 with cardiogenic shock) who were mechanically ventilated upon admission. The study has two main objectives: Determine how often acid-base disorders occur in these patients and describe their characteristics. Compare the initial ventilator settings chosen by clinicians with those suggested by VentilO, a decision-support algorithm. The investigators will evaluate the potential effect of the VentilO recommendations on the first arterial (or capillary) blood gases compared to the real settings. This information will help refine the algorithm and guide future research on improving ventilation strategies for critically ill cardiac patients. Participation does not involve any intervention, as the study uses existing medical records.
Interventions
Blood gases evaluation after initiation of mechanical ventilation
Sponsors
Laval University
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Adult (Age \>=18 years old) * Under mechanical ventilation with endotracheal tube for : post cardiac arrest or cardiogenic shock \- Bood gases result availability up to 4 hours after coronary unit admission
Exclusion criteria
* Lack of patient anthropometric data (height and weight) available in the patient record * No information in the record regarding the data on the humidification systems used at the time of the first blood gas test upon admission to the coronary care unit. * Patient stabilzed in other hospital before coronary unit admission or adjustment of respiratory parameters after a blood gas test.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Acid-base disorder (respiratory acidosis) | Up to 4 hours after admission to the coronary care unit - First blood gas sample | Presence of respiratory acisosis define by pH\< 7.35 and PaCO2 \> 45 mmHg |
| Acid-base disorder (respiratory alcalosis) | Up to 4 hours after admission to the coronary care unit - First blood gas sample | Presence of respiratory alcalosis define by by pH\>7.45 and PaCO2 \< 35 mmHg |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Ventilator setting (Respiratory rate) | Up to 4 hour after coronary unit admission - At the last ventilator setting before blood gas sample | Respiratory rate set by the doctor, these setting will be compared to the suggestion of the algorithm |
| Ventilator setting (Tidal volume) | Up to 4 hour after coronary unit admission - At the last ventilator setting before blood gas sample | Tidal volume set by the doctor, these setting will be compared to the suggestion of the algorithm |
| Acid-base disorder (metabolic acidosis) | Up to 4 hours after admission to the coronary care unit - First blood gas sample | Presence of metabolic acidosis define by HCO3 \< 20 mmol/L |
| Acid-base disorder (metabolic alcalosis) | Up to 4 hours after admission to the coronary care unit - First blood gas sample | Presence of metabolic acidosis define by HCO3 \> 28 mmol/L |
| Optimal acid-base result | Up to 4 hours after admission to the coronary care unit - First blood gas sample | Presence of optimal pH (7.35-7.45) with optimal PCO2 (35-45 mmHg) |
| Mechanical ventilation duration | Up to 90 days | Time spent with invasive mechanical ventilation aftercoronary unit admission and hospital discharge |
| Vasopressor duration | Day 28 | Duration of vasopressor or inotrop administration |
| Hospital length of stay | Up to 90 days | Coronary unit admission through hospital discharge |
| Mortality | Day 28 | Mortality at coronary unit |
| Acute renal failure | Up to 90 days. Coronary unit stay - admission through discharge or until death if occured | Rate of acute renal failure during coronary unit length of stay. Renal failure will be defined according to the usual criteria, i.e., an increase of \>27 mmol/L creatinine in 48 hours or 1.5x over the baseline |
Countries
Canada
Contacts
CONTACTFrancois Lellouche
Outcome results
None listed