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
{"title":"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。","authors":"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","doi":"10.1016/j.jclinane.2024.111728","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Patients receiving intraoperative ventilation during general anesthesia often have low end-tidal CO<sub>2</sub> (etCO<sub>2</sub>). We examined the association of intraoperative etCO<sub>2</sub> 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).</p><p><strong>Methods: </strong>Patients at high risk of PPCs were categorized as 'low etCO<sub>2</sub>' or 'normal to high etCO<sub>2</sub>' 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 etCO<sub>2</sub> and PPCs.</p><p><strong>Results: </strong>The analysis included 1843 (74 %) 'low etCO<sub>2</sub>' patients and 648 (26 %) 'normal to high etCO<sub>2</sub>' patients. There was no difference in the occurrence of PPCs between 'low etCO<sub>2</sub>' and 'normal to high etCO<sub>2</sub>' 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 etCO<sub>2</sub>' patients compared to 'normal to high etCO<sub>2</sub>' 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 etCO<sub>2</sub> levels with the occurrence of PPCs.</p><p><strong>Conclusions: </strong>In this cohort of patients at high risk of PPCs, the overall occurrence of PPCs was not different between 'low etCO<sub>2</sub>' patients and 'normal to high etCO<sub>2</sub>' patients, but severe PPCs occurred more often in 'low etCO<sub>2</sub>', with an inverse dose-dependent relationship between intraoperative etCO<sub>2</sub> levels and PPCs.</p><p><strong>Funding: </strong>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'.</p><p><strong>Registration: </strong>LAS VEGAS was registered at Clinicaltrials.gov (NCT01601223), first posted on May 17, 2012.</p>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"111728"},"PeriodicalIF":5.0000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Associations of intraoperative end-tidal CO<sub>2</sub> levels with postoperative outcome-secondary analysis of a worldwide observational study.\",\"authors\":\"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\",\"doi\":\"10.1016/j.jclinane.2024.111728\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Patients receiving intraoperative ventilation during general anesthesia often have low end-tidal CO<sub>2</sub> (etCO<sub>2</sub>). We examined the association of intraoperative etCO<sub>2</sub> 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).</p><p><strong>Methods: </strong>Patients at high risk of PPCs were categorized as 'low etCO<sub>2</sub>' or 'normal to high etCO<sub>2</sub>' 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 etCO<sub>2</sub> and PPCs.</p><p><strong>Results: </strong>The analysis included 1843 (74 %) 'low etCO<sub>2</sub>' patients and 648 (26 %) 'normal to high etCO<sub>2</sub>' patients. There was no difference in the occurrence of PPCs between 'low etCO<sub>2</sub>' and 'normal to high etCO<sub>2</sub>' 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 etCO<sub>2</sub>' patients compared to 'normal to high etCO<sub>2</sub>' 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 etCO<sub>2</sub> levels with the occurrence of PPCs.</p><p><strong>Conclusions: </strong>In this cohort of patients at high risk of PPCs, the overall occurrence of PPCs was not different between 'low etCO<sub>2</sub>' patients and 'normal to high etCO<sub>2</sub>' patients, but severe PPCs occurred more often in 'low etCO<sub>2</sub>', with an inverse dose-dependent relationship between intraoperative etCO<sub>2</sub> levels and PPCs.</p><p><strong>Funding: </strong>This analysis was performed without additional funding. 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Associations of intraoperative end-tidal CO2 levels with postoperative outcome-secondary analysis of a worldwide observational study.
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.
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.
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