Association Between Arterial Carbon Dioxide Tension and Outcome in Patients Admitted to the Intensive Care Unit After Coronary Artery Bypass Surgery.

Abstract

OBJECTIVES The aim of this study was to determine the association between PaCO2 and patient outcome in patients admitted to the intensive care unit (ICU) after coronary artery bypass grafting (CABG). DESIGN A retrospective cohort study. SETTING Single-institutional, university hospital. PARTICIPANTS All patients admitted to the ICU after CABG between January 2009 and December 2012. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Based on PaCO2 status during the first 24 hours after CABG, 1,011 patients were classified into 4 groups: normocapnia, hypocapnia, hypercapnia, and dual hyper/hypocapnia. The 30-day mortality rate was 0.7% (n = 4) for normocapnia, 1.5% (n = 4) for hypocapnia, 2.2% (n = 3) for hypercapnia, and 7.5% (n = 4) for the dual-exposure group. The extubation times were 13.3±21.7 hours, 15.8±21.37 hours, 21.79±39.70 hours, and 42.29±75.35 hours, respectively. After adjusting for confounding variables, the dual hypocapnia and hypercapnia exposure group was associated with increased 30-day mortality (odds ratio [OR] = 8.08; 95% confidence interval [CI], 1.82-35.86; p = 0.006) and delayed extubation (OR = 2.40; 95% CI, 1.24-4.64; p = 0.010). CONCLUSIONS Exposure to both hypocapnia and hypercapnia within 24 hours after CABG was associated independently with increased risk of 30-day mortality and delayed extubation. Exposure to either hypocapnia or hypercapnia alone was not associated with patient outcome.