• Ryan Davis, Elizabeth Jewell, Milo Engoren, and Michael Maile.
• Department of Anesthesiology, University of Michigan Medical School, 1500 E. Medical Center Dr., UH 1H247, Ann Arbor, MI, 48105, USA. ryda@med.umich.edu.
• Can J Anaesth. 2022 Jan 1; 69 (1): 106-118.

PurposeThe difference between arterial and end-tidal partial pressure of carbon dioxide (ΔCO2) is a measure of alveolar dead space, commonly evaluated intraoperatively. Given its relationship to ventilation and perfusion, ΔCO2 may provide prognostic information and guide clinical decisions. We hypothesized that higher ΔCO2 values are associated with occurrence of a composite outcome of re-intubation, postoperative mechanical ventilation, or 30-day mortality in patients undergoing non-cardiac surgery.MethodsWe conducted a historical cohort study of adult patients undergoing non-cardiac surgery with an arterial line at a single tertiary care medical centre. The composite outcome, identified from electronic health records, was re-intubation, postoperative mechanical ventilation, or 30-day mortality. Student's t test and Chi-squared test were used for univariable analysis. Logistic regression was used for multivariable analysis of the relationship of ΔCO2 with the composite outcome.ResultsA total of 19,425 patients were included in the final study population. Univariable analysis showed an association between higher mean (standard deviation [SD]) intraoperative ΔCO2 values and the composite outcome (6.1 [5.3] vs 5.7 [4.5] mm Hg; P = 0.002). After adjusting for baseline subject characteristics, every 5-mm Hg increase in the ΔCO2 was associated with a nearly 20% increased odds of the composite outcome (odds ratio, 1.20; 95% confidence interval, 1.12 to 1.28; P < 0.001).ConclusionsIn this patient population, increased intraoperative ΔCO2 was associated with an increased odds of the composite outcome of postoperative mechanical ventilation, re-intubation, or 30-day mortality that was independent of its relationship with pre-existing pulmonary disease. Future studies are needed to determine if ΔCO2 can be used to guide patient management and improve patient outcomes.© 2021. Canadian Anesthesiologists' Society.

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