• Anissa M Tsonas, Michela Botta, Janneke Horn, Luis Morales-Quinteros, Antonio Artigas, Marcus J Schultz, Frederique Paulus, NetoAry SerpaASDepartment of Intensive Care, Amsterdam UMC, location 'AMC', Amsterdam, the Netherlands; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil; Department of Critical Care Medicine, Australian and New Z, and PRoVENT-COVID Collaborative Group.
• Department of Intensive Care, Amsterdam UMC, location 'AMC', Amsterdam, the Netherlands. Electronic address: a.m.tsonas@amsterdamumc.nl.
• J Crit Care. 2022 Jun 1; 69: 154022154022.

PurposeWe determined the incidence of hypercapnia and associations with outcome in invasively ventilated COVID-19 patients.MethodsPosthoc analysis of a national, multicenter, observational study in 22 ICUs. Patients were classified as 'hypercapnic' or 'normocapnic' in the first three days of invasive ventilation. Primary endpoint was prevalence of hypercapnia. Secondary endpoints were ventilator parameters, length of stay (LOS) in ICU and hospital, and mortality in ICU, hospital, at day 28 and 90.ResultsOf 824 patients, 485 (58.9%) were hypercapnic. Hypercapnic patients had a higher BMI and had COPD, severe ARDS and venous thromboembolic events more often. Hypercapnic patients were ventilated with lower tidal volumes, higher respiratory rates, higher driving pressures, and with more mechanical power of ventilation. Hypercapnic patients had comparable minute volumes but higher ventilatory ratios than normocapnic patients. In hypercapnic patients, ventilation and LOS in ICU and hospital was longer, but mortality was comparable to normocapnic patients.ConclusionHypercapnia occurs often in invasively ventilated COVID-19 patients. Main differences between hypercapnic and normocapnic patients are severity of ARDS, occurrence of venous thromboembolic events, and a higher ventilation ratio. Hypercapnia has an association with duration of ventilation and LOS in ICU and hospital, but not with mortality.Copyright © 2022. Published by Elsevier Inc.

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