Kim June-Sung, Kim Youn-Jung, Kim Muyeol, Ryoo Seung Mok, Sohn Chang Hwan, Ahn Shin, Kim Won Young
Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea.
J Clin Med. 2020 Feb 14;9(2):527. doi: 10.3390/jcm9020527.
(1) Background: Acute respiratory distress syndrome (ARDS) following cardiac arrest is common and associated with in-hospital mortality. We aim to investigate whether lung compliance during targeted temperature management is associated with neurological outcome in patients with ARDS after out-of-hospital cardiac arrest (OHCA). (2) Methods: This observational study is conducted in the emergency intensive care unit from January 2011 to April 2019 using data from a prospective patient registry. Adult patients (age ≥18 years) who survived non-traumatic OHCA and subsequently developed ARDS based on the Berlin definition are included. Mechanical ventilator parameters such as plateau pressure, tidal volume, minute ventilation, positive end expiratory pressure, and compliance are recorded for 7 days or until death, and categorized as maximum, median, and minimum. The primary outcome is a favorable neurological outcome defined as a Cerebral Performance Category score of 1 or 2 at hospital discharge. (3) Results: Regarding 246 OHCA survivors, 119 (48.4%) patients developed ARDS. A favorable neurologic outcome was observed in 23 (19.3%). Patients with a favorable outcome have a significantly higher lung compliance (38.6 mL/cm HO versus 27.5 mL/cm HO), lower inspiratory pressure (12.0 cm HO versus 16.0 cm HO), and lower plateau pressure (17.0 cm HO versus 21.0 cm HO) than those with a poor neurologic outcome (all < 0.01). Concerning time-dependent cox regression models, all maximum (adjusted hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.02-1.09), minimum (HR 1.08, 95% CI 1.03-1.13), and median (HR 1.06, 95% CI 1.02-1.09) compliances are independently associated with a good neurologic outcome. Maximum compliance, >32.5 mL/cm HO at day 1, has the highest area under the receiver operating characteristic curve (0.745) with a positive predictive value of 90.4%. (4) Conclusions: Lung compliance may be an early predictor of intact neurologic survival in patients with ARDS following cardiac arrest.
（1）背景：心脏骤停后急性呼吸窘迫综合征（ARDS）很常见，且与院内死亡率相关。我们旨在研究目标温度管理期间的肺顺应性是否与院外心脏骤停（OHCA）后发生ARDS患者的神经功能结局相关。（2）方法：本观察性研究于2011年1月至2019年4月在急诊重症监护病房进行，使用前瞻性患者登记数据。纳入非创伤性OHCA存活且随后根据柏林定义发生ARDS的成年患者（年龄≥18岁）。记录机械通气参数，如平台压、潮气量、分钟通气量、呼气末正压和顺应性，为期7天或直至死亡，并分为最大值、中位数和最小值。主要结局是良好的神经功能结局定义为出院时脑功能分类评分为1或2。（3）结果：在246例OHCA幸存者中，119例（48.4%）患者发生ARDS。23例（19.3%）观察到良好的神经功能结局。与神经功能结局不良的患者相比，结局良好的患者肺顺应性显著更高（38.6 mL/cm H₂O对27.5 mL/cm H₂O）、吸气压力更低（12.0 cm H₂O对16.0 cm H₂O）、平台压更低（17.0 cm H₂O对21.0 cm H₂O）（均P<0.01）。关于时间依赖性Cox回归模型，所有最大值（调整后危险比[HR] 1.05，95%置信区间[CI] 1.02 - 1.09）、最小值（HR 1.08，95% CI 1.03 - 1.13）和中位数（HR 1.06，95% CI 1.02 - 1.09）顺应性均与良好的神经功能结局独立相关。第1天最大顺应性>32.5 mL/cm H₂O在受试者工作特征曲线下面积最高（0.745），阳性预测值为90.4%。（4）结论：肺顺应性可能是心脏骤停后ARDS患者神经功能完整存活的早期预测指标。
