An Exploratory Analysis of the Association between Hypercapnia and Hospital Mortality in Critically Ill Patients with Sepsis

Tiruvoipati, Ravindranath; Neto, Ary Serpa; Young, Marcus; Marhoon, Nada; Wilson, John F.; Gupta, Sachin; Pilcher, David; Bailey, Michael; Bellomo, Rinaldo

doi:10.1513/annalsats.202102-104oc

Cited by 11 publications

(6 citation statements)

References 39 publications

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“…Such lung protective ventilation strategies may cause hypercapnic acidosis in some patients. Several recent studies have shown that acute hypercapnia, especially when associated with acidosis, is associated with an increased risk of mortality and morbidity (3–7). Low-flow extracorporeal carbon dioxide removal (ECCO 2 R) devices are currently used to correct hypercapnia and hypercapnic acidosis while instituting lung protective ventilation (8–11).…”

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confidence: 99%

Extracorporeal Carbon Dioxide Removal With the Hemolung in Patients With Acute Respiratory Failure: A Multicenter Retrospective Cohort Study*

Tiruvoipati¹,

Akkanti²,

Dinh³

et al. 2023

Critical Care Medicine

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Objectives: Extracorporeal carbon dioxide removal (ECCO2R) devices are effective in reducing hypercapnia and mechanical ventilation support but have not been shown to reduce mortality. This may be due to case selection, device performance, familiarity, or the management. The objective of this study is to investigate the effectiveness and safety of a single ECCO2R device (Hemolung) in patients with acute respiratory failure and identify variables associated with survival that could help case selection in clinical practice as well as future research. Design: Multicenter, multinational, retrospective review. Setting: Data from the Hemolung Registry between April 2013 and June 2021, where 57 ICUs contributed deidentified data. Patients: Patients with acute respiratory failure treated with the Hemolung. The characteristics of patients who survived to ICU discharge were compared with those who died. Multivariable logistical regression analysis was used to identify variables associated with ICU survival. Interventions: None. Measurements and Main Results: Of the 159 patients included, 65 (41%) survived to ICU discharge. The survival was highest in status asthmaticus (86%), followed by acute respiratory distress syndrome (ARDS) (52%) and COVID-19 ARDS (31%). All patients had a significant reduction in Paco2 and improvement in pH with reduction in mechanical ventilation support. Patients who died were older, had a lower Pao2:Fio2 (P/F) and higher use of adjunctive therapies. There was no difference in the complications between patients who survived to those who died. Multivariable regression analysis showed non-COVID-19 ARDS, age less than 65 years, and P/F at initiation of ECCO2R to be independently associated with survival to ICU discharge (P/F 100–200 vs <100: odds ratio, 6.57; 95% CI, 2.03–21.33). Conclusions: Significant improvement in hypercapnic acidosis along with reduction in ventilation supports was noted within 4 hours of initiating ECCO2R. Non-COVID-19 ARDS, age, and P/F at commencement of ECCO2R were independently associated with survival.

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confidence: 99%

Extracorporeal Carbon Dioxide Removal With the Hemolung in Patients With Acute Respiratory Failure: A Multicenter Retrospective Cohort Study*

Tiruvoipati¹,

Akkanti²,

Dinh³

et al. 2023

Critical Care Medicine

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“…17 Además, cuando la acidosis hipercápnica se prolonga más de 48 horas el riesgo de fallecer es mayor (OR 6.22, IC95% 1.59-24.34; p = 0.009). 18 El paciente con acidemia respiratoria (PaCO 2 > 50 mmHg y pH < 7.23), sólo por ese diagnóstico alcanza mortalidad de 20%; y si se agregara acidosis metabólica el riesgo de muerte será hasta 30%. 19 En nuestro trabajo, el grupo de hipercapnia tuvo media de PaCO 2 de 57.02 mmHg y pH de 7.26 con mortalidad de 52.2%, pero sin diferencia estadística con respecto a los grupos de hipocapnia y normocapnia.…”

Section: Discussionunclassified

Efecto del CO2 sobre la mortalidad en pacientes con SDRA por COVID-19

González Arce,

Sánchez Díaz,

Peniche Moguel

et al. 2024

Medicina Crítica

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RESUMENIntroducción: la neumonía grave por SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) incrementó la incidencia de SDRA (síndrome de distrés respiratorio agudo). La ventilación protectora disminuye la mortalidad en pacientes con SDRA, dicha estrategia ventilatoria basada en el uso de volumen corriente bajo podría ocasionar hipercapnia. Las alteraciones del CO 2 son tan importantes como las de oxigenación en el SDRA. Objetivo: evaluar el efecto del CO 2 sobre la mortalidad en pacientes con SDRA por COVID-19 con ventilación mecánica invasiva (VMI). Material y métodos: estudio cohorte, retrospectivo, observacional, longitudinal. Se realizó en la unidad de cuidados intensivos (UCI) entre el 1 de junio de 2020 y el 31 de diciembre de 2022. Estudio de no intervención. Resultados: se incluyeron 115 pacientes, 61.7% hombres. Se clasificaron en tres grupos de acuerdo al valor de PaCO 2 de ingreso a unidad de cuidados intensivos: grupo 1 (hipocapnia): PaCO 2 < 35 mmHg, grupo 2 (normocapnia): PaCO 2 35-45 mmHg, grupo 3 (hipercapnia): PaCO 2 > 45 mmHg. La mortalidad global fue de 53%. El grupo 1 presentó OR 0.640 (IC95% 0.181-2.265) p = 0.488, grupo 2 OR1.66 (IC95% 0.673-4.130) p = 0.270 y grupo 3 OR 0.992 (IC95% 0.396-2.489) p = 0.98; otras variables como eficiencia ventilatoria y frecuencia respiratoria presentaron relación inversa a mortalidad con valor de 1.4 y 24, respectivamente. Conclusión: la PaCO 2 no es un factor de riesgo para predecir mortalidad en los pacientes con SDRA secundario a COVID-19 con ventilación mecánica invasiva. Otras variables como la eficiencia ventilatoria y la frecuencia respiratoria son mediciones pronósticas en nuestra población. Palabras clave: síndrome de distrés respiratorio agudo, COVID-19, PaCO 2 , mortalidad.

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“…Tiruvoipati and his colleagues [ 32 ] found that in patients with sepsis who received mechanical ventilation, CV-PaCO 2 showed a persistent association with an increased odds ratio for mortality, likely reflecting physiological instability. Similarly, an early rapid change in PaCO 2 after ECMO in patients with respiratory failure was correlated with an increased risk of neurological complications [ 33 ]. Regrettably, none of the above studies investigated the effects of daily PaCO 2 in ARDS patients and failed to represent the frequency and persistence of abnormal carbon dioxide exposure.…”

Section: Discussionmentioning

confidence: 99%

Association between the time-varying arterial carbon dioxide pressure and 28-day mortality in mechanically ventilated patients with acute respiratory distress syndrome

et al. 2023

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Background Recent studies have shown an association between baseline arterial carbon dioxide pressure (PaCO2) and outcomes in patients with acute respiratory distress syndrome (ARDS). However, PaCO2 probably varies throughout the disease, and few studies have assessed the effect of longitudinal PaCO2 on prognosis. We thus aimed to investigate the association between time-varying PaCO2 and 28-day mortality in mechanically ventilated ARDS patients. Methods In this retrospective study, we included all adult (≥ 18 years) patients diagnosed with ARDS who received mechanical ventilation for at least 24 h at a tertiary teaching hospital between January 2014 and March 2021. Patients were excluded if they received extracorporeal membrane oxygenation (ECMO). Demographic data, respiratory variables, and daily PaCO2 were extracted. The primary outcome was 28-day mortality. Time-varying Cox models were used to estimate the association between longitudinal PaCO2 measurements and 28-day mortality. Results A total of 709 patients were eligible for inclusion in the final cohort, with an average age of 65 years, of whom 70.7% were male, and the overall 28-day mortality was 35.5%. After adjustment for baseline confounders, including age and severity of disease, a significant increase in the hazard of death was found to be associated with both time-varying PaCO2 (HR 1.07, 95% CI 1.03–1.11, p<0.001) and the time-varying coefficient of variation for PaCO2 (HR 1.24 per 10% increase, 95% CI 1.10–1.40, p<0.001) during the first five days of invasive mechanical ventilation. The cumulative proportion of exposure to normal PaCO2 (HR 0.72 per 10% increase, 95% CI 0.58–0.89, p = 0.002) was associated with 28-day mortality. Conclusion PaCO2 should be closely monitored in mechanically ventilated ARDS patients. The association between PaCO2 and 28-day mortality persisted over time. Increased cumulative exposure to normal PaCO2 was associated with a decreased risk of death.

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An Exploratory Analysis of the Association between Hypercapnia and Hospital Mortality in Critically Ill Patients with Sepsis

Cited by 11 publications

References 39 publications

Extracorporeal Carbon Dioxide Removal With the Hemolung in Patients With Acute Respiratory Failure: A Multicenter Retrospective Cohort Study*

Extracorporeal Carbon Dioxide Removal With the Hemolung in Patients With Acute Respiratory Failure: A Multicenter Retrospective Cohort Study*

Efecto del CO2 sobre la mortalidad en pacientes con SDRA por COVID-19

Association between the time-varying arterial carbon dioxide pressure and 28-day mortality in mechanically ventilated patients with acute respiratory distress syndrome

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