@article{a59b3e542ec34f8f89cb964048537b76,
title = "Association between Partial Pressure of Arterial Carbon Dioxide and Survival to Hospital Discharge among Patients Diagnosed with Sepsis in the Emergency Department",
abstract = "Objective: The objective of this study was to test the association between the partial pressure of arterial carbon dioxide and survival to hospital discharge among mechanically ventilated patients diagnosed with sepsis in the emergency department. Design: Retrospective cohort study of a single center trial registry. Setting: Academic medical center. Patients: Mechanically ventilated emergency department patients. Inclusion criteria: age 18 years and older, diagnosed with sepsis in the emergency department, and mechanical ventilation initiated in the emergency department. Interventions: Arterial blood gases obtained after initiation of mechanical ventilation were analyzed. The primary outcome was survival to hospital discharge. We tested the association between partial pressure of arterial carbon dioxide and survival using multivariable logistic regression adjusting for potential confounders. Sensitivity analyses, including propensity score matching were also performed. Measurements and Main Results: Six hundred subjects were included, and 429 (72%) survived to hospital discharge. The median (interquartile range) partial pressure of arterial carbon dioxide was 42 (34-53) mm Hg for the entire cohort and 44 (35-57) and 39 (31-45) mm Hg among survivors and nonsurvivors, respectively (p < 0.0001 Wilcox rank-sum test). On multivariable analysis, a 1mm Hg rise in partial pressure of arterial carbon dioxide was associated with a 3% increase in odds of survival (adjusted odds ratio, 1.03; 95% CI, 1.01-1.04) after adjusting for tidal volume and other potential confounders. These results remained significant on all sensitivity analyses. Conclusion: In this sample of mechanically ventilated sepsis patients, we found an association between increasing levels of partial pressure of arterial carbon dioxide and survival to hospital discharge. These findings justify future studies to determine the optimal target partial pressure of arterial carbon dioxide range for mechanically ventilated sepsis patients.",
keywords = "Mechanical ventilation, Paco2, partial pressure of arterial carbon dioxide, sepsis",
author = "Roberts, {Brian W.} and Mohr, {Nicholas M.} and Enyo Ablordeppey and Drewry, {Anne M.} and Ferguson, {Ian T.} and Stephen Trzeciak and Kollef, {Marin H.} and Fuller, {Brian M.}",
note = "Funding Information: B.M.F. and A.M.D. were funded by the KL2 Career Development Award, and this research was supported by the Washington University Institute of Clinical and Translational Sciences (Grants UL1 TR000448 and KL2 TR000450) from the National Center for Advancing Translational Sciences. B.M.F. was also funded by the Foundation for Barnes-Jewish Hospital Clinical and Translational Sciences Research Program (Grant # 8041–88). A.M.D. was also funded by the Foundation for Anesthesia Education and Research. N.M.M. was supported by grant funds from the Health Resources and Services Administration. E.A.A. was supported by Washington University School of Medicine Faculty grant and the Funding Information: Foundation for Barnes Jewish Hospital grant. M.H.K. was supported by the Barnes-Jewish Hospital Foundation. B.W.R. was supported by a grant from the National Institutes of Health/National Heart, Lung, and Blood Institute (K23HL126979). Drs. Roberts, Drewry, and Fuller received support for article research from National Institutes of Health (NIH). Dr. Roberts{\textquoteright} institution received funding from National Heart, Lung, and Blood Institute. Dr. Ablordeppey{\textquoteright}s institution received funding from the Washington University School of Medicine and the Barnes Jewish Hospital Foundation. Dr. Drewry{\textquoteright}s institution received funding from the NIH. Dr. Fuller{\textquoteright}s institution received funding from the Foundation for Barnes-Jewish Hospital Clinical and Translational Sciences Research Program (Grant # 8041–88) and a KL2 Career Development Award, and this research was supported by the Washington University Institute of Clinical and Translational Sciences (Grants UL1 TR000448 and KL2 TR000450) from the National Center for Advancing Translational Sciences. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: roberts-brian-w@ cooperhealth.edu Publisher Copyright: Copyright {\textcopyright} 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.",
year = "2018",
month = mar,
day = "1",
doi = "10.1097/CCM.0000000000002918",
language = "English",
volume = "46",
pages = "E213--E220",
journal = "Critical Care Medicine",
issn = "0090-3493",
number = "3",
}