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Clinical practice and effect of carbon dioxide on outcomes in mechanically ventilated acute brain-injured patients: a secondary analysis of the ENIO study.
Robba, Chiara; Battaglini, Denise; Abbas, Abbas; Sarrió, Ezequiel; Cinotti, Raphael; Asehnoune, Karim; Taccone, Fabio S; Rocco, Patricia R; Schultz, Marcus J; Citerio, Giuseppe; Stevens, Robert David; Badenes, Rafael.
Afiliación
  • Robba C; Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy. kiarobba@gmail.com.
  • Battaglini D; Department of Surgical Science and Integrated Diagnostic, University of Genova, Genoa, Italy. kiarobba@gmail.com.
  • Abbas A; Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
  • Sarrió E; Department of Surgical Science and Integrated Diagnostic, University of Genova, Genoa, Italy.
  • Cinotti R; Department of Surgery, University of Valencia, Valencia, Spain.
  • Asehnoune K; Department of Anaesthesia and Critical Care, CHU Nantes, Nantes Université, Hôtel Dieu, 44000, Nantes, France.
  • Taccone FS; UMR 1246 SPHERE "MethodS in Patients-Centered Outcomes and HEalth Research", INSERM, IRS2 22 Boulevard Benoni Goulin, University of Nantes, University of Tours, 44200, Nantes, France.
  • Rocco PR; Department of Anaesthesia and Critical Care, CHU Nantes, Nantes Université, Hôtel Dieu, 44000, Nantes, France.
  • Schultz MJ; Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium.
  • Citerio G; Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho, 373, Rio de Janeiro, Brazil.
  • Stevens RD; Department of Clinical Medicine, University of Oxford Nuffield, Oxford, Oxfordshire, 105596, UK.
  • Badenes R; Department of Intensive Care, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, The Netherlands.
Intensive Care Med ; 50(2): 234-246, 2024 Feb.
Article en En | MEDLINE | ID: mdl-38294526
ABSTRACT

PURPOSE:

The use of arterial partial pressure of carbon dioxide (PaCO2) as a target intervention to manage elevated intracranial pressure (ICP) and its effect on clinical outcomes remain unclear. We aimed to describe targets for PaCO2 in acute brain injured (ABI) patients and assess the occurrence of abnormal PaCO2 values during the first week in the intensive care unit (ICU). The secondary aim was to assess the association of PaCO2 with in-hospital mortality.

METHODS:

We carried out a secondary analysis of a multicenter prospective observational study involving adult invasively ventilated patients with traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), intracranial hemorrhage (ICH), or ischemic stroke (IS). PaCO2 was collected on day 1, 3, and 7 from ICU admission. Normocapnia was defined as PaCO2 > 35 and to 45 mmHg; mild hypocapnia as 32-35 mmHg; severe hypocapnia as 26-31 mmHg, forced hypocapnia as < 26 mmHg, and hypercapnia as > 45 mmHg.

RESULTS:

1476 patients (65.9% male, mean age 52 ± 18 years) were included. On ICU admission, 804 (54.5%) patients were normocapnic (incidence 1.37 episodes per person/day during ICU stay), and 125 (8.5%) and 334 (22.6%) were mild or severe hypocapnic (0.52 and 0.25 episodes/day). Forced hypocapnia and hypercapnia were used in 40 (2.7%) and 173 (11.7%) patients. PaCO2 had a U-shape relationship with in-hospital mortality with only severe hypocapnia and hypercapnia being associated with increased probability of in-hospital mortality (omnibus p value = 0.0009). Important differences were observed across different subgroups of ABI patients.

CONCLUSIONS:

Normocapnia and mild hypocapnia are common in ABI patients and do not affect patients' outcome. Extreme derangements of PaCO2 values were significantly associated with increased in-hospital mortality.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Dióxido de Carbono / Hipocapnia Tipo de estudio: Clinical_trials / Observational_studies Límite: Adult / Female / Humans / Male Idioma: En Revista: Intensive Care Med Año: 2024 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Dióxido de Carbono / Hipocapnia Tipo de estudio: Clinical_trials / Observational_studies Límite: Adult / Female / Humans / Male Idioma: En Revista: Intensive Care Med Año: 2024 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Estados Unidos