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.
Study Type
OBSERVATIONAL
Enrollment
100
Blood gases evaluation after initiation of mechanical ventilation
Insitut universitaire de cardiologie et de pneumologie de Quebec - Universite Laval
Québec, Quebec, Canada
Acid-base disorder (respiratory acidosis)
Presence of respiratory acisosis define by pH\< 7.35 and PaCO2 \> 45 mmHg
Time frame: Up to 4 hours after admission to the coronary care unit - First blood gas sample
Acid-base disorder (respiratory alcalosis)
Presence of respiratory alcalosis define by by pH\>7.45 and PaCO2 \< 35 mmHg
Time frame: Up to 4 hours after admission to the coronary care unit - First blood gas sample
Ventilator setting (Respiratory rate)
Respiratory rate set by the doctor, these setting will be compared to the suggestion of the algorithm
Time frame: Up to 4 hour after coronary unit admission - At the last ventilator setting before blood gas sample
Ventilator setting (Tidal volume)
Tidal volume set by the doctor, these setting will be compared to the suggestion of the algorithm
Time frame: Up to 4 hour after coronary unit admission - At the last ventilator setting before blood gas sample
Acid-base disorder (metabolic acidosis)
Presence of metabolic acidosis define by HCO3 \< 20 mmol/L
Time frame: Up to 4 hours after admission to the coronary care unit - First blood gas sample
Acid-base disorder (metabolic alcalosis)
Presence of metabolic acidosis define by HCO3 \> 28 mmol/L
Time frame: Up to 4 hours after admission to the coronary care unit - First blood gas sample
Optimal acid-base result
Presence of optimal pH (7.35-7.45) with optimal PCO2 (35-45 mmHg)
Time frame: Up to 4 hours after admission to the coronary care unit - First blood gas sample
Mechanical ventilation duration
Time spent with invasive mechanical ventilation aftercoronary unit admission and hospital discharge
Time frame: Up to 90 days
Vasopressor duration
Duration of vasopressor or inotrop administration
Time frame: Day 28
Hospital length of stay
Coronary unit admission through hospital discharge
Time frame: Up to 90 days
Mortality
Mortality at coronary unit
Time frame: Day 28
Acute renal failure
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
Time frame: Up to 90 days. Coronary unit stay - admission through discharge or until death if occured
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