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

doi:10.1016/j.jcrc.2017.04.033

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

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Abstract

Purpose To describe the prevalence of hypocapnia and hypercapnia during the earliest period of mechanical ventilation, and determine the association between P_aCO₂ and mortality. Materials and Methods: A cohort study using an emergency department registry of mechanically ventilated patients. P_aCO₂ 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. P_aCO₂ 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 P_aCO₂, there was a linear trend of increasing survival up to a P_aCO₂ 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 P_aCO₂ levels were associated with increased survival. These data provide rationale for a trial examining the optimal P_aCO₂ in the critically ill.

Original language	English
Pages (from-to)	29-35
Number of pages	7
Journal	Journal of Critical Care
Volume	41
DOIs	https://doi.org/10.1016/j.jcrc.2017.04.033
State	Published - Oct 1 2017

Keywords

Clinical outcomes
Hypercapnia
Mechanical ventilation

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10.1016/j.jcrc.2017.04.033

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@article{90c0597edeb740caa211ba2f7e8eb612,

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

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.",

keywords = "Clinical outcomes, Hypercapnia, Mechanical ventilation",

author = "Fuller, {Brian M.} and Mohr, {Nicholas M.} and Drewry, {Anne M.} and Ferguson, {Ian T.} and Stephen Trzeciak and Kollef, {Marin H.} and Roberts, {Brian W.}",

note = "Funding Information: Funding: BMF and AMD 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 (NCATS). BMF was also funded by the Foundation for Barnes-Jewish Hospital Clinical and Translational Sciences Research Program (Grant # 8041-88). AMD was also funded by the Foundation for Anesthesia Education and Research. NMM was supported by grant funds from the Health Resources and Services Administration. MHK was supported by the Barnes-Jewish Hospital Foundation. BWR was supported by a grant from the National Institutes of Health/National Heart, Lung, and Blood Institute (K23HL126979). Funders played no role in the design and conduct of the study, nor the collection, management, analysis, and interpretation of the data, nor the preparation, review, or approval of the manuscript. Publisher Copyright: {\textcopyright} 2017 Elsevier Inc.",

year = "2017",

month = oct,

day = "1",

doi = "10.1016/j.jcrc.2017.04.033",

language = "English",

volume = "41",

pages = "29--35",

journal = "Journal of Critical Care",

issn = "0883-9441",

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TY - JOUR

T1 - Partial pressure of arterial carbon dioxide and survival to hospital discharge among patients requiring acute mechanical ventilation

T2 - A cohort study

AU - Fuller, Brian M.

AU - Mohr, Nicholas M.

AU - Drewry, Anne M.

AU - Ferguson, Ian T.

AU - Trzeciak, Stephen

AU - Kollef, Marin H.

AU - Roberts, Brian W.

N1 - Funding Information: Funding: BMF and AMD 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 (NCATS). BMF was also funded by the Foundation for Barnes-Jewish Hospital Clinical and Translational Sciences Research Program (Grant # 8041-88). AMD was also funded by the Foundation for Anesthesia Education and Research. NMM was supported by grant funds from the Health Resources and Services Administration. MHK was supported by the Barnes-Jewish Hospital Foundation. BWR was supported by a grant from the National Institutes of Health/National Heart, Lung, and Blood Institute (K23HL126979). Funders played no role in the design and conduct of the study, nor the collection, management, analysis, and interpretation of the data, nor the preparation, review, or approval of the manuscript. Publisher Copyright: © 2017 Elsevier Inc.

PY - 2017/10/1

Y1 - 2017/10/1

N2 - 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.

AB - 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.

KW - Clinical outcomes

KW - Hypercapnia

KW - Mechanical ventilation

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DO - 10.1016/j.jcrc.2017.04.033

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C2 - 28472700

AN - SCOPUS:85020695368

SN - 0883-9441

VL - 41

SP - 29

EP - 35

JO - Journal of Critical Care

JF - Journal of Critical Care

ER -

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

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