Nasa Prashant, van Meenen David M P, Paulus Frederique, de Abreu Marcelo Gama, Bossers Sebastiaan M, Schober Patrick, Schultz Marcus J, Neto Ary Serpa, Hemmes Sabrine N T
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.
Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Department of Anaesthesiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Department of Intensive Care & Laboratory of Experimental Intensive Care and Anaesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Amsterdam, The Netherlands.
J Clin Anesth. 2025 Feb;101:111728. doi: 10.1016/j.jclinane.2024.111728. Epub 2024 Dec 19.
Patients receiving intraoperative ventilation during general anesthesia often have low end-tidal CO (etCO). We examined the association of intraoperative etCO 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).
Patients at high risk of PPCs were categorized as 'low etCO' or 'normal to high etCO' 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 etCO and PPCs.
The analysis included 1843 (74 %) 'low etCO' patients and 648 (26 %) 'normal to high etCO' patients. There was no difference in the occurrence of PPCs between 'low etCO' and 'normal to high etCO' 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 etCO' patients compared to 'normal to high etCO' 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 etCO levels with the occurrence of PPCs.
In this cohort of patients at high risk of PPCs, the overall occurrence of PPCs was not different between 'low etCO' patients and 'normal to high etCO' patients, but severe PPCs occurred more often in 'low etCO', with an inverse dose-dependent relationship between intraoperative etCO levels and PPCs.
This 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'.
LAS VEGAS was registered at Clinicaltrials.gov (NCT01601223), first posted on May 17, 2012.
全身麻醉期间接受术中通气的患者常常存在呼气末二氧化碳分压（etCO）偏低的情况。在一项规模适中的名为“手术全身麻醉期间通气管理的局部评估”（LAS VEGAS）的国际前瞻性研究中，我们探讨了术中etCO水平与术后肺部并发症（PPC）发生之间的关联。
将PPC高风险患者分为“低etCO”或“正常至高etCO”患者，以35 mmHg为界值。主要终点是先前定义的PPC的复合指标；各个PPC作为次要终点。计划外吸氧需求被定义为轻度PPC，严重PPC包括肺炎、呼吸衰竭、急性呼吸窘迫综合征、气压伤和新的有创通气。我们进行了倾向评分匹配和局部加权回归，以评估最低etCO与PPC之间的关系。
分析纳入了1843例（74%）“低etCO”患者和648例（26%）“正常至高etCO”患者。“低etCO”患者和“正常至高etCO”患者之间PPC的发生率没有差异（20%对19%；相对危险度1.00 [95%置信区间0.94至1.06]；P = 0.84）。在所有发生的PPC中，“低etCO”患者中严重PPC的比例高于“正常至高etCO”患者（35%对18%；相对危险度1.16 [1.08至1.25]；P < 0.001）。倾向评分匹配并未改变这些结果。局部加权回归图显示术中etCO水平与PPC的发生呈负相关。
在这个PPC高风险患者队列中，“低etCO”患者和“正常至高etCO”患者之间PPC的总体发生率没有差异，但严重PPC在“低etCO”患者中更常发生，术中etCO水平与PPC之间存在剂量依赖性负相关。
本分析未获得额外资金。LAS VEGAS由欧洲麻醉与重症监护学会（ESAIC）和阿姆斯特丹大学医学中心“AMC”部分资助并认可。
LAS VEGAS在Clinicaltrials.gov（NCT01601223）注册，于2012年5月17日首次发布。
