Ventilator Settings for the Post-Arrest Patient

• The majority of patients with ROSC from OHCA require intubation and mechanical ventilation.
• Correctly managing the ventilator in the post-arrest patient is critical for improving outcomes.
• As patients are at high risk for ARDS, use lung-protective ventilation with tidal volumes between 6 to 8 ml/kg of ideal body weight and PEEP of 5 to 8 cm H2O.
• There is a U-shaped relationship between neurologic outcomes and both PaO2 and PaCO2.
  • Target normoxia (SpO2 94% to 96%) and avoid hyperoxia and hypoxia.
  • Target normocapnia (PaCO2 40 to 50 mm Hg) and avoid hypercapnia and hypocapnia.
• Use an analgosedation approach with short-acting analgesics and sedatives, such as fentanyl and propofol.

References

Jentzer JC, et al. Recent developments in the management of patients resuscitated from cardiac arrest. J Crit Care. 2017; 39:97-107.