Severe hypercapnia and outcome of mechanically ventilated patients with moderate or severe acute respiratory distress syndrome

• Published in: Intensive care medicine 2017-02, Vol.43 (2), p.200-208
• Main Authors: Nin, Nicolas, Muriel, Alfonso, Peñuelas, Oscar, Brochard, Laurent, Lorente, José Angel, Ferguson, Niall D., Raymondos, Konstantinos, Ríos, Fernando, Violi, Damian A., Thille, Arnaud W., González, Marco, Villagomez, Asisclo J., Hurtado, Javier, Davies, Andrew R., Du, Bin, Maggiore, Salvatore M., Soto, Luis, D’Empaire, Gabriel, Matamis, Dimitrios, Abroug, Fekri, Moreno, Rui P., Soares, Marco Antonio, Arabi, Yaseen, Sandi, Freddy, Jibaja, Manuel, Amin, Pravin, Koh, Younsuck, Kuiper, Michael A., Bülow, Hans-Henrik, Zeggwagh, Amine Ali, Anzueto, Antonio, Sznajder, Jacob I., Esteban, Andres
• Format: Article
• Language: English
• Subjects: Acidosis; Acute respiratory distress syndrome; Adult; Aged; Analysis; Anesthesiology; Canada; Critical Care Medicine; Emergency Medicine; Female; Humans; Hypercapnia; Hypercapnia - etiology; Hypercapnia - mortality; Hypercapnia - therapy; Intensive; Intensive care; Intensive Care Units; Length of stay; Logistic Models; Male; Medical colleges; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Mortality; Original; Pain Medicine; Patient outcomes; Pediatrics; Pneumology/Respiratory System; Propensity Score; Prospective Studies; Regression analysis; Respiration, Artificial - adverse effects; Respiratory distress syndrome; Respiratory Distress Syndrome, Adult - complications; Respiratory Distress Syndrome, Adult - mortality; Respiratory Distress Syndrome, Adult - therapy; Severity of Illness Index; Simplified Acute Physiology Score; Spain; Time Factors; United Kingdom; Variables; Ventilators
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-016-4611-1

Purpose To 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 methods We 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 outcomes We included 1899 patients with ARDS in this study. The relationship between maximum PaCO 2 in the first 48 h and mortality suggests higher mortality at or above PaCO 2 of ≥50 mmHg. Patients with severe hypercapnia (PaCO 2 ≥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, PaO 2 /FiO 2 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). Conclusions Severe hypercapnia appears to be independently associated with higher ICU mortality in patients with ARDS. Trial registration Clinicaltrials.gov identifier, NCT01093482.