Impact of Arterial CO2 Retention in Patients With Moderate or Severe ARDS.
Background: Lung-protective ventilation (reduced tidal volume and limited plateau pressure) may lead to CO2 retention. Data about the impact of hypercapnia in patients with ARDS are scarce and conflicting. Methods: We performed a non-interventional cohort study with subjects with ARDS admitted from...
| Publicado en: | Respiratory Care Vol. 68; no. 5; pp. 582 - 592 |
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| Autores principales: | , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
May2023
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=163323491&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 163323491 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: May2023 vid: 68 iid: 5 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 163323491 163323491 163323491 10.4187/respcare.10507 163323491 ppf: 582 ppct: 10 formats: fmt: @attributes: type: P tig: atl: Impact of Arterial CO2 Retention in Patients With Moderate or Severe ARDS. aug: au: Maamar, Adel Delamaire, Flora Reizine, Florian Lesouhaitier, Mathieu Painvin, Benoit Quelven, Quentin Coirier, Valentin Guillot, Pauline Le Tulzo, Yves Tadié, Jean Marc Gacouin, Arnaud affil: Centre Hospitalier Universitaire Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France sug: subj: Respiratory Distress Syndrome, Acute Carbon Dioxide Blood Respiration, Artificial Methods Hypercapnia Human Young Adult Radiography Prospective Studies Time Factors Descriptive Statistics Odds Ratio Confidence Intervals Intensive Care Units Death Retrospective Design Chi Square Test Mann-Whitney U Test Multiple Logistic Regression P-Value Acidosis Pulmonary Disease, Chronic Obstructive Pneumonia Spearman's Rank Correlation Coefficient Comparative Studies Scales ab: Background: Lung-protective ventilation (reduced tidal volume and limited plateau pressure) may lead to CO2 retention. Data about the impact of hypercapnia in patients with ARDS are scarce and conflicting. Methods: We performed a non-interventional cohort study with subjects with ARDS admitted from 2006 to 2021 and with PaO2 /FIO2 ≤ 150 mm Hg. We examined the association between severe hypercapnia (PaCO2 ≥ 50 mm Hg) on the first 5 days after the diagnosis of ARDS and death in ICU for 930 subjects. All the subjects received lung-protective ventilation. Results: Severe hypercapnia was noted in 552 subjects (59%) on the first day of ARDS (day 1); 323/930 (34.7%) died in the ICU. Severe hypercapnia on day 1 was associated with mortality in the unadjusted (odds ratio 1.54, 95% CI 1.16-1.63; P = .003) and adjusted (odds ratio 1.47, 95% CI 1.08-2.43; P = .004) models. In the Bayesian analysis, the posterior probability that severe hypercapnia was associated with ICU death was > 90% in 4 different priors, including a septic prior for this association. Sustained severe hypercapnia on day 5, defined as severe hypercapnia present from day 1 to day 5, was noted in 93 subjects (12%). After propensity score matching, severe hypercapnia on day 5 remained associated with ICU mortality (odds ratio 1.73, 95% CI 1.02-2.97; P = .047). Conclusions: Severe hypercapnia was associated with mortality in subjects with ARDS who received lung-protective ventilation. Our results deserve further evaluation of the strategies and treatments that aim to control CO2 retention. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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