• Prashant Nasa, van MeenenDavid M PDMPDepartment of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Department of Anaesthesiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Department of Intensive Care & Laborator, Frederique Paulus, Marcelo Gama de Abreu, Sebastiaan M Bossers, Patrick Schober, Marcus J Schultz, NetoAry SerpaASAustralian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Intensive Care, Austin Hospital, Melbourne, Australia; Department , HemmesSabrine N TSNTDepartment of Anaesthesiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Department of Anaesthesiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., LAS VEGAS-investigators, PROVE Network, ESAIC CTN, and LAS VEGAS collaborators.
• Department of Anaesthesia and Critical Care Medicine, The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, United Kingdom; Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands. Electronic address: dr.prashantnasa@hotmail.com.
• J Clin Anesth. 2025 Feb 1; 101: 111728111728.

BackgroundPatients 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).MethodsPatients 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.ResultsThe 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.ConclusionsIn 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.FundingThis 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'.RegistrationLAS VEGAS was registered at Clinicaltrials.gov (NCT01601223), first posted on May 17, 2012.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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