Associations of intraoperative end-tidal CO2 levels with postoperative outcome-secondary analysis of a worldwide observational study.

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; LAS VEGAS-investigators; PROVE Network; ESAIC CTN; LAS VEGAS collaborators

doi:10.1016/j.jclinane.2024.111728

Article (Scientific journals)

Associations of intraoperative end-tidal CO2 levels with postoperative outcome-secondary analysis of a worldwide observational study.

Nasa, Prashant; van Meenen, David M P; Paulus, Frederique et al.

2025 • In Journal of Clinical Anesthesia, 101, p. 111728

Peer Reviewed verified by ORBi

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https://hdl.handle.net/2268/329327

DOI
10.1016/j.jclinane.2024.111728

PubMed
39705739

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Keywords :

Anesthesia, intraoperative ventilation; CO(2); Carbon dioxide; End–tidal CO(2); Invasive ventilation; PPCs; Postoperative pulmonary complications; Ventilation; etCO(2); Carbon Dioxide; Humans; Male; Female; Prospective Studies; Middle Aged; Aged; Respiration, Artificial/statistics & numerical data; Tidal Volume; Adult; Lung Diseases/etiology; Lung Diseases/epidemiology; Monitoring, Intraoperative/methods; Carbon Dioxide/analysis; Postoperative Complications/etiology; Postoperative Complications/epidemiology; Anesthesia, General/adverse effects; CO2; End–tidal CO2; etCO2; Anesthesia, General; Lung Diseases; Monitoring, Intraoperative; Postoperative Complications; Respiration, Artificial; Anesthesiology and Pain Medicine

Abstract :

[en] [en] BACKGROUND: Patients receiving intraoperative ventilation during general anesthesia often have low end-tidal CO2 (etCO2). We examined the association of intraoperative etCO2 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). METHODS: Patients at high risk of PPCs were categorized as 'low etCO2' or 'normal to high etCO2' 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 etCO2 and PPCs. RESULTS: The analysis included 1843 (74 %) 'low etCO2' patients and 648 (26 %) 'normal to high etCO2' patients. There was no difference in the occurrence of PPCs between 'low etCO2' and 'normal to high etCO2' 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 etCO2' patients compared to 'normal to high etCO2' 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 etCO2 levels with the occurrence of PPCs. CONCLUSIONS: In this cohort of patients at high risk of PPCs, the overall occurrence of PPCs was not different between 'low etCO2' patients and 'normal to high etCO2' patients, but severe PPCs occurred more often in 'low etCO2', with an inverse dose-dependent relationship between intraoperative etCO2 levels and PPCs. FUNDING: 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'. REGISTRATION: LAS VEGAS was registered at Clinicaltrials.gov (NCT01601223), first posted on May 17, 2012.

Disciplines :

Anesthesia & intensive care

Author, co-author :

Nasa, Prashant; 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. Electronic address: dr.prashantnasa@hotmail.com

van Meenen, David M P; 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

Paulus, Frederique; Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands

de Abreu, Marcelo Gama; Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany, Department of Intensive Care and Resuscitation and Outcomes Research, Cleveland Clinic, Cleveland, OH, United States of America, Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH, United States of America

Bossers, Sebastiaan M; Department of Anaesthesiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands

Schober, Patrick; Department of Anaesthesiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands, Helicopter Emergency Medical Service Lifeliner 1, Amsterdam, The Netherlands

Schultz, Marcus J; Department of Intensive Care, 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, Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom, Department of Anaesthesia, General Intensive Care and Pain Management, Division of Cardiothoracic and Vascular Anaesthesia & Critical Care Medicine, Medical University of Vienna, Vienna, Austria

Neto, Ary Serpa; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, Department of Intensive Care, Austin Hospital, Melbourne, Australia, Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia, Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil

Hemmes, Sabrine N T; Department of Anaesthesiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands, Department of Anaesthesiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

LAS VEGAS-investigators

More authors (3 more)

Other collaborator :

Lois, Fernande ; Centre Hospitalier Universitaire de Liège - CHU > > Service d'anesthésie - réanimation

Language :

English

Title :

Associations of intraoperative end-tidal CO2 levels with postoperative outcome-secondary analysis of a worldwide observational study.

Publication date :

February 2025

Journal title :

Journal of Clinical Anesthesia

ISSN :

0952-8180

Publisher :

Elsevier, United States

Volume :

101

Pages :

111728

Peer reviewed :

Peer Reviewed verified by ORBi

Additional URL :

https://api.elsevier.com/content/article/PII:S0952818024003581?httpAccept=text/xml

Funding text :

This research was performed without any additional grant from funding agencies in the public, commercial, or not-for-profit sectors. LAS VEGAS was partially funded and endorsed by the European Society of Anaesthesiology and Intensive Care (ESAIC) and the Amsterdam University Medical Centers, location \u2018AMC\u2019.

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