• Nicolas Nin, Alfonso Muriel, Oscar Peñuelas, Laurent Brochard, José Angel Lorente, Niall D Ferguson, Konstantinos Raymondos, Fernando Ríos, Damian A Violi, Arnaud W Thille, Marco González, Asisclo J Villagomez, Javier Hurtado, Andrew R Davies, Bin Du, Salvatore M Maggiore, Luis Soto, Gabriel D'Empaire, Dimitrios Matamis, Fekri Abroug, Rui P Moreno, Marco Antonio Soares, Yaseen Arabi, Freddy Sandi, Manuel Jibaja, Pravin Amin, Younsuck Koh, Michael A Kuiper, Hans-Henrik Bülow, Amine Ali Zeggwagh, Antonio Anzueto, Jacob I Sznajder, Andres Esteban, and VENTILA Group.
• Hospital de Torrejón, Madrid, Spain.
• Intensive Care Med. 2017 Feb 1; 43 (2): 200-208.

PurposeTo analyze the relationship between hypercapnia developing within the first 48 h after the start of mechanical ventilation and outcome in patients with acute respiratory distress syndrome (ARDS).Patients And MethodsWe performed a secondary analysis of three prospective non-interventional cohort studies focusing on ARDS patients from 927 intensive care units (ICUs) in 40 countries. These patients received mechanical ventilation for more than 12 h during 1-month periods in 1998, 2004, and 2010. We used multivariable logistic regression and a propensity score analysis to examine the association between hypercapnia and ICU mortality.Main OutcomesWe included 1899 patients with ARDS in this study. The relationship between maximum PaCO2 in the first 48 h and mortality suggests higher mortality at or above PaCO2 of ≥50 mmHg. Patients with severe hypercapnia (PaCO2 ≥50 mmHg) had higher complication rates, more organ failures, and worse outcomes. After adjusting for age, SAPS II score, respiratory rate, positive end-expiratory pressure, PaO2/FiO2 ratio, driving pressure, pressure/volume limitation strategy (PLS), corrected minute ventilation, and presence of acidosis, severe hypercapnia was associated with increased risk of ICU mortality [odds ratio (OR) 1.93, 95% confidence interval (CI) 1.32 to 2.81; p = 0.001]. In patients with severe hypercapnia matched for all other variables, ventilation with PLS was associated with higher ICU mortality (OR 1.58, CI 95% 1.04-2.41; p = 0.032).ConclusionsSevere hypercapnia appears to be independently associated with higher ICU mortality in patients with ARDS.Trial RegistrationClinicaltrials.gov identifier, NCT01093482.

27 keywords...

hide…