Journal article
Partial pressure of arterial carbon dioxide and survival to hospital discharge among patients requiring acute mechanical ventilation: A cohort study
Journal of critical care, Vol.41, pp.29-35
10/2017
DOI: 10.1016/j.jcrc.2017.04.033
PMCID: PMC5633513
PMID: 28472700
Abstract
To describe the prevalence of hypocapnia and hypercapnia during the earliest period of mechanical ventilation, and determine the association between PaCO2 and mortality.
Materials and Methods: A cohort study using an emergency department registry of mechanically ventilated patients. PaCO2 was categorized: hypocapnia (<35mmHg), normocapnia (35–45mmHg), and hypercapnia (>45mmHg). The primary outcome was survival to hospital discharge.
A total of 1,491 patients were included. Hypocapnia occurred in 375 (25%) patients and hypercapnia in 569 (38%). Hypercapnia (85%) had higher survival rate compared to normocapnia (74%) and hypocapnia (66%), P<0.001. PaCO2 was an independent predictor of survival to hospital discharge [hypocapnia (aOR 0.65 (95% confidence interval [CI] 0.48–0.89), normocapnia (reference category), hypercapnia (aOR 1.83 (95% CI 1.32–2.54)]. Over ascending ranges of PaCO2, there was a linear trend of increasing survival up to a PaCO2 range of 66–75mmHg, which had the strongest survival association, aOR 3.18 (95% CI 1.35–7.50).
Hypocapnia and hypercapnia occurred frequently after initiation of mechanical ventilation. Higher PaCO2 levels were associated with increased survival. These data provide rationale for a trial examining the optimal PaCO2 in the critically ill.
•Hypocapnia and hypercapnia occur frequently after initiation of mechanical ventilation.•Higher PaCO2 levels are associated with increased survival.•Over ascending PaCO2, there is linear trend of increased survival up to PaCO2 of 66 - 75 mmHg, which has highest survival.
Details
- Title: Subtitle
- Partial pressure of arterial carbon dioxide and survival to hospital discharge among patients requiring acute mechanical ventilation: A cohort study
- Creators
- Brian M Fuller - Departments of Emergency Medicine and Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, United StatesNicholas M Mohr - Departments of Emergency Medicine and Anesthesiology, Division of Critical Care Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, 200 Hawkins Drive, 1008 RCP, Iowa City, IA 52242, United StatesAnne M Drewry - Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, United StatesIan T Ferguson - School of Medicine and Medical Science, University College Dublin, Dublin 4, IrelandStephen Trzeciak - Departments of Medicine and Emergency Medicine, Division of Critical Care Medicine, Cooper University Hospital, One Cooper Plaza, K152, Camden, NJ 08103, United StatesMarin H Kollef - Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, United StatesBrian W Roberts - Department of Emergency Medicine, Cooper University Hospital, One Cooper Plaza, K152, Camden, NJ 08103, United States
- Resource Type
- Journal article
- Publication Details
- Journal of critical care, Vol.41, pp.29-35
- DOI
- 10.1016/j.jcrc.2017.04.033
- PMID
- 28472700
- PMCID
- PMC5633513
- NLM abbreviation
- J Crit Care
- ISSN
- 0883-9441
- eISSN
- 1557-8615
- Publisher
- Elsevier Inc
- Language
- English
- Date published
- 10/2017
- Academic Unit
- Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center
- Record Identifier
- 9984024402402771
Metrics
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