Associations of intraoperative end-tidal CO₂ levels with postoperative outcome-secondary analysis of a worldwide observational study.

IF 5 2区医学 Q1 ANESTHESIOLOGY Journal of Clinical Anesthesia Pub Date : 2025-02-01 Epub Date: 2024-12-19 DOI:10.1016/j.jclinane.2024.111728

Prashant Nasa, David M P van Meenen, Frederique Paulus, Marcelo Gama de Abreu, Sebastiaan M Bossers, Patrick Schober, Marcus J Schultz, Ary Serpa Neto, Sabrine N T Hemmes

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Abstract

Background: Patients receiving intraoperative ventilation during general anesthesia often have low end-tidal CO₂ (etCO₂). We examined the association of intraoperative etCO₂ levels with the occurrence of postoperative pulmonary complications (PPCs) in a conveniently-sized international, prospective study named 'Local ASsessment of Ventilatory management during General Anesthesia for Surgery' (LAS VEGAS).

Methods: Patients at high risk of PPCs were categorized as 'low etCO₂' or 'normal to high etCO₂' patients, using a cut-off of 35 mmHg. The primary endpoint was a composite of previously defined PPCs; the individual PPCs served as secondary endpoints. The need for unplanned oxygen was defined as mild PPCs and severe PPCs included pneumonia, respiratory failure, acute respiratory distress syndrome, barotrauma, and new invasive ventilation. We performed propensity score matching and LOESS regression to evaluate the relationship between the lowest etCO₂ and PPCs.

Results: The analysis included 1843 (74 %) 'low etCO₂' patients and 648 (26 %) 'normal to high etCO₂' patients. There was no difference in the occurrence of PPCs between 'low etCO₂' and 'normal to high etCO₂' patients (20 % vs. 19 %; RR 1.00 [95 %-confidence interval 0.94 to 1.06]; P = 0.84). The proportion of severe PPCs among total occurring PPCs, were higher in 'low etCO₂' patients compared to 'normal to high etCO₂' patients (35 % vs. 18 %; RR 1.16 [1.08 to 1.25]; P < 0.001). Propensity score matching did not change these findings. LOESS plot showed an inverse relationship of intraoperative etCO₂ levels with the occurrence of PPCs.

Conclusions: In this cohort of patients at high risk of PPCs, the overall occurrence of PPCs was not different between 'low etCO₂' patients and 'normal to high etCO₂' patients, but severe PPCs occurred more often in 'low etCO₂', with an inverse dose-dependent relationship between intraoperative etCO₂ levels and PPCs.

Funding: This analysis was performed without additional funding. LAS VEGAS was partially funded and endorsed by the European Society of Anesthesiology and Intensive Care (ESAIC) and the Amsterdam University Medical Centers, location 'AMC'.

Registration: LAS VEGAS was registered at Clinicaltrials.gov (NCT01601223), first posted on May 17, 2012.

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术中潮末CO2水平与术后结果的关系——一项全球观察性研究的二次分析。

背景：在全身麻醉期间接受术中通气的患者通常潮气末二氧化碳（etCO2）较低。我们在一项名为 "手术全身麻醉期间通气管理的地方评估"（LAS VEGAS）的国际前瞻性研究中，研究了术中 etCO2 水平与术后肺部并发症（PPCs）发生率的关系：方法：以 35 mmHg 为临界值，将 PPC 高风险患者分为 "低 etCO2 "和 "正常至高 etCO2 "患者。主要终点是之前定义的 PPCs 综合结果；单个 PPCs 作为次要终点。计划外吸氧需求被定义为轻度 PPCs，重度 PPCs 包括肺炎、呼吸衰竭、急性呼吸窘迫综合征、气压创伤和新的有创通气。我们进行了倾向得分匹配和 LOESS 回归，以评估最低 etCO2 与 PPCs 之间的关系：分析包括 1843 例（74%）"低 etCO2 "患者和 648 例（26%）"正常至高 etCO2 "患者。低 etCO2 "和 "正常至高 etCO2 "患者的 PPCs 发生率没有差异（20 % 对 19 %；RR 1.00 [95 % 置信区间 0.94 至 1.06]；P = 0.84）。低 etCO2 "患者与 "正常至高 etCO2 "患者相比，发生严重 PPCs 的比例更高（35 % vs. 18 %；RR 1.16 [1.08 至 1.25]；P = 0.84）：结论：在这组 PPCs 高危患者中，"低 etCO2 "患者和 "正常至高 etCO2 "患者的 PPCs 总发生率没有差异，但 "低 etCO2 "患者发生严重 PPCs 的频率更高，术中 etCO2 水平与 PPCs 之间存在剂量依赖关系：本分析未获得额外资助。LAS VEGAS由欧洲麻醉学与重症监护学会（ESAIC）和阿姆斯特丹大学医疗中心（AMC）提供部分资金支持：LAS VEGAS已在Clinicaltrials.gov（NCT01601223）注册，并于2012年5月17日首次发布。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.