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
Hospital de Torrejón, Madrid, Spain.
Hospital Español, Montevideo, Uruguay.
Intensive Care Med. 2017 Feb;43(2):200-208. doi: 10.1007/s00134-016-4611-1. Epub 2017 Jan 20.
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).
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.
We included 1899 patients with ARDS in this study. The relationship between maximum PaCO in the first 48 h and mortality suggests higher mortality at or above PaCO of ≥50 mmHg. Patients with severe hypercapnia (PaCO ≥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/FiO 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).
Severe hypercapnia appears to be independently associated with higher ICU mortality in patients with ARDS.
Clinicaltrials.gov identifier, NCT01093482.
分析急性呼吸窘迫综合征（ARDS）患者机械通气开始后48小时内发生的高碳酸血症与预后的关系。
我们对来自40个国家927个重症监护病房（ICU）的ARDS患者进行了三项前瞻性非干预队列研究的二次分析。这些患者在1998年、2004年和2010年的1个月期间接受了超过12小时的机械通气。我们使用多变量逻辑回归和倾向评分分析来检验高碳酸血症与ICU死亡率之间的关联。
本研究纳入了1899例ARDS患者。最初48小时内最高动脉血二氧化碳分压（PaCO₂）与死亡率之间的关系表明，PaCO₂≥50 mmHg及以上时死亡率更高。严重高碳酸血症（PaCO₂≥50 mmHg）患者的并发症发生率更高、器官衰竭更多且预后更差。在调整年龄、简化急性生理学评分II（SAPS II）、呼吸频率、呼气末正压、动脉血氧分压/吸入氧浓度（PaO₂/FiO₂）比值、驱动压、压力/容量限制策略（PLS）、校正分钟通气量和酸中毒情况后，严重高碳酸血症与ICU死亡风险增加相关[比值比（OR）1.93，95%置信区间（CI）1.32至2.81；p = 0.001]。在所有其他变量匹配的严重高碳酸血症患者中，采用PLS通气与更高的ICU死亡率相关（OR 1.58，95% CI 1.04 - 2.41；p = 0.032）。
严重高碳酸血症似乎与ARDS患者更高的ICU死亡率独立相关。
Clinicaltrials.gov标识符，NCT01093482。
