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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Patient post cardiac arrest |
| ||
| Patient with cardiogenic shock |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Initiation of mechanical ventilation | Other | Blood gases evaluation after initiation of mechanical ventilation |
|
| Measure | Description | Time Frame |
|---|---|---|
| Acid-base disorder (respiratory acidosis) | Presence of respiratory acisosis define by pH< 7.35 and PaCO2 > 45 mmHg | 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 | Up to 4 hours after admission to the coronary care unit - First blood gas sample |
| Measure | Description | Time Frame |
|---|---|---|
| Ventilator setting (Respiratory rate) | Respiratory rate set by the doctor, these setting will be compared to the suggestion of the algorithm | Up to 4 hour after coronary unit admission - At the last ventilator setting before blood gas sample |
| Ventilator setting (Tidal volume) |
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Inclusion Criteria:
post cardiac arrest or cardiogenic shock
- Bood gases result availability up to 4 hours after coronary unit admission
Exclusion Criteria:
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post cardiac arrest or cardiogenic shock
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Francois Lellouche | Contact | 1-418-656-8711 | 3572 | francois.lellouche@criucpq.ulaval.ca |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Insitut universitaire de cardiologie et de pneumologie de Quebec - Universite Laval | Québec | Quebec | G1V4G5 | Canada |
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Tidal volume set by the doctor, these setting will be compared to the suggestion of the algorithm |
| 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 | 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 | 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) | 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 | Up to 90 days |
| Vasopressor duration | Duration of vasopressor or inotrop administration | Day 28 |
| Hospital length of stay | Coronary unit admission through hospital discharge | Up to 90 days |
| Mortality | Mortality at coronary unit | 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 | Up to 90 days. Coronary unit stay - admission through discharge or until death if occured |
| ID | Term |
|---|---|
| D006323 | Heart Arrest |
| D012770 | Shock, Cardiogenic |
| ID | Term |
|---|---|
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D009203 | Myocardial Infarction |
| D017202 | Myocardial Ischemia |
| D014652 | Vascular Diseases |
| D007238 | Infarction |
| D007511 | Ischemia |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D009336 | Necrosis |
| D012769 | Shock |
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