Partial pressure of arterial carbon dioxide and survival to hospital discharge among patients requiring acute mechanical ventilation: A cohort study

Brian M. Fuller, Nicholas M. Mohr, Anne M. Drewry, Ian T. Ferguson, Stephen Trzeciak, Marin H. Kollef, Brian W. Roberts

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Purpose 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 (< 35 mm Hg), normocapnia (35–45 mm Hg), and hypercapnia (> 45 mm Hg). The primary outcome was survival to hospital discharge. Results 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 66–75 mm Hg, which had the strongest survival association, aOR 3.18 (95% CI 1.35–7.50). Conclusions 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.

Original languageEnglish
Pages (from-to)29-35
Number of pages7
JournalJournal of Critical Care
Volume41
DOIs
StatePublished - Oct 1 2017

Keywords

  • Clinical outcomes
  • Hypercapnia
  • Mechanical ventilation

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