Associations of intraoperative end–tidal CO2 levels with postoperative outcome–secondary analysis of a worldwide observational study
Articolo
Data di Pubblicazione:
2025
Citazione:
Associations of intraoperative end–tidal CO2 levels with postoperative
outcome–secondary analysis of a worldwide observational study / Nasa, Prashant; Van Meenen, David M. P.; Paulus, Frederique; Gama De Abre, Marcelo; Bossers, Sebastiaan M.; Schober, Patrick; Schultz, Marcus J.; Serpa Neto, Ary; Hemmes, Sabrine N. T.; Pistidda, Laura. - In: JOURNAL OF CLINICAL ANESTHESIA. - ISSN 0952-8180. - (2025). [10.1016/j.jclinane.2024.111728]
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.
(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.
Tipologia CRIS:
1.1 Articolo in rivista
Keywords:
Anesthesia, intraoperative ventilation
Invasive ventilation
Ventilation
Carbon dioxide
CO2
End–tidal CO2
etCO2
Postoperative pulmonary complications
PPCs
Elenco autori:
Nasa, Prashant; Van Meenen, David M. P.; Paulus, Frederique; Gama De Abre, Marcelo; Bossers, Sebastiaan M.; Schober, Patrick; Schultz, Marcus J.; Serpa Neto, Ary; Hemmes, Sabrine N. T.; Pistidda, Laura
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