Severe hypercapnia and outcome of mechanically ventilated patients with moderate or severe acute respiratory distress syndrome

Nicolas Nin; Alfonso Muriel; Oscar Peñuelas; Laurent Brochard; José Angel Lorente; Niall D. Ferguson; Konstantinos Raymondos; Fernando Ríos; Damian A. Violi; Arnaud W. Thille; Marco González; Asisclo J. Villagomez; Javier Hurtado; Andrew R. Davies; Bin Du; Salvatore M. Maggiore; Luis Soto; Gabriel D’Empaire; Dimitrios Matamis; Fekri Abroug; Rui P. Moreno; Marco Antonio Soares; Yaseen Arabi; Freddy Sandi; Manuel Jibaja; Pravin Amin; Younsuck Koh; Michael A. Kuiper; Hans Henrik Bülow; Amine Ali Zeggwagh; Antonio Anzueto; Jacob I. Sznajder; Andres Esteban; the VENTILA Group for the VENTILA Group

doi:10.1007/s00134-016-4611-1

Severe hypercapnia and outcome of mechanically ventilated patients with moderate or severe acute respiratory distress syndrome

Nicolas Nin
, Alfonso Muriel
, Oscar Peñuelas
, Laurent Brochard
, José Angel Lorente
, Niall D. Ferguson
, Konstantinos Raymondos
, Fernando Ríos
, Damian A. Violi
, Arnaud W. Thille
, Marco González
, Asisclo J. Villagomez
, Javier Hurtado
, Andrew R. Davies
, Bin Du
, Salvatore M. Maggiore
, Luis Soto
, Gabriel D’Empaire
, Dimitrios Matamis
, Fekri Abroug

Rui P. Moreno, Marco Antonio Soares, Yaseen Arabi, Freddy Sandi, Manuel Jibaja, Pravin Amin, Younsuck Koh, Michael A. Kuiper, Hans Henrik Bülow, Amine Ali Zeggwagh, Antonio Anzueto, Jacob I. Sznajder, Andres Esteban^*, the VENTILA Group for the VENTILA Group

^*Corresponding author for this work

Hospital de Torrejón
Hospital Español
Hospital Ramon y Cajal
Uruguay and Centro Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES)
Hospital Universitario de Getafe
University of Toronto
University of Toronto Faculty of Medicine
Medizinische Hochschule Hannover
National Hospital Alejandro Posadas
Hospital HIGA Guemes
CHU de Poitiers
Universidad Pontificia Bolivariana
Hospital Regional 1° de Octubre ISSSTE
Monash University
Chinese Academy of Medical Sciences
Università Cattolica Del Sacro Cuore
Instituto Nacional del Tórax
Hospital de Clínicas de Caracas
Papageorgiou Hospital
Hospital Fattouma Bourguina
Hospital São José
Hospital Universitario Sao José
King Saud bin Abdulaziz University for Health Sciences
Hospital Obrero No. 1
Hospital Eugenio Espejo
Bombay Hospital Institute of Medical Sciences
University of Ulsan
Medical Center Leeuwarden (MCL)
University of Copenhagen
Ibn Sina Hospital, Agdal Rabat
South Texas Veterans Health Care System
Northwestern University

Research output: Contribution to journal › Article › peer-review

194 Scopus citations

Abstract

Purpose: To analyze the relationship between hypercapnia developing within the first 48 h after the start of mechanical ventilation and outcome in patients with acute respiratory distress syndrome (ARDS). Patients and methods: We performed a secondary analysis of three prospective non-interventional cohort studies focusing on ARDS patients from 927 intensive care units (ICUs) in 40 countries. These patients received mechanical ventilation for more than 12 h during 1-month periods in 1998, 2004, and 2010. We used multivariable logistic regression and a propensity score analysis to examine the association between hypercapnia and ICU mortality. Main outcomes: We included 1899 patients with ARDS in this study. The relationship between maximum PaCO₂ in the first 48 h and mortality suggests higher mortality at or above PaCO₂ of ≥50 mmHg. Patients with severe hypercapnia (PaCO₂ ≥50 mmHg) had higher complication rates, more organ failures, and worse outcomes. After adjusting for age, SAPS II score, respiratory rate, positive end-expiratory pressure, PaO₂/FiO₂ ratio, driving pressure, pressure/volume limitation strategy (PLS), corrected minute ventilation, and presence of acidosis, severe hypercapnia was associated with increased risk of ICU mortality [odds ratio (OR) 1.93, 95% confidence interval (CI) 1.32 to 2.81; p = 0.001]. In patients with severe hypercapnia matched for all other variables, ventilation with PLS was associated with higher ICU mortality (OR 1.58, CI 95% 1.04–2.41; p = 0.032). Conclusions: Severe hypercapnia appears to be independently associated with higher ICU mortality in patients with ARDS. Trial registration: Clinicaltrials.gov identifier, NCT01093482.

Original language	English
Pages (from-to)	200-208
Number of pages	9
Journal	Intensive Care Medicine
Volume	43
Issue number	2
DOIs	https://doi.org/10.1007/s00134-016-4611-1
State	Published - 1 Feb 2017
Externally published	Yes

Keywords

Acute respiratory distress syndrome
Hypercapnia
ICU mortality
Mechanical ventilation

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Nin, N., Muriel, A., Peñuelas, O., Brochard, L., Lorente, J. A., Ferguson, N. D., Raymondos, K., Ríos, F., Violi, D. A., Thille, A. W., González, M., Villagomez, A. J., Hurtado, J., Davies, A. R., Du, B., Maggiore, S. M., Soto, L., D’Empaire, G., Matamis, D., ... for the VENTILA Group, T. VENTILA. G. (2017). Severe hypercapnia and outcome of mechanically ventilated patients with moderate or severe acute respiratory distress syndrome. Intensive Care Medicine, 43(2), 200-208. https://doi.org/10.1007/s00134-016-4611-1

@article{093d0fb90f8c468890d027ebcadcc98e,

title = "Severe hypercapnia and outcome of mechanically ventilated patients with moderate or severe acute respiratory distress syndrome",

abstract = "Purpose: To analyze the relationship between hypercapnia developing within the first 48 h after the start of mechanical ventilation and outcome in patients with acute respiratory distress syndrome (ARDS). Patients and methods: We performed a secondary analysis of three prospective non-interventional cohort studies focusing on ARDS patients from 927 intensive care units (ICUs) in 40 countries. These patients received mechanical ventilation for more than 12 h during 1-month periods in 1998, 2004, and 2010. We used multivariable logistic regression and a propensity score analysis to examine the association between hypercapnia and ICU mortality. Main outcomes: We included 1899 patients with ARDS in this study. The relationship between maximum PaCO2 in the first 48 h and mortality suggests higher mortality at or above PaCO2 of ≥50 mmHg. Patients with severe hypercapnia (PaCO2 ≥50 mmHg) had higher complication rates, more organ failures, and worse outcomes. After adjusting for age, SAPS II score, respiratory rate, positive end-expiratory pressure, PaO2/FiO2 ratio, driving pressure, pressure/volume limitation strategy (PLS), corrected minute ventilation, and presence of acidosis, severe hypercapnia was associated with increased risk of ICU mortality [odds ratio (OR) 1.93, 95\% confidence interval (CI) 1.32 to 2.81; p = 0.001]. In patients with severe hypercapnia matched for all other variables, ventilation with PLS was associated with higher ICU mortality (OR 1.58, CI 95\% 1.04–2.41; p = 0.032). Conclusions: Severe hypercapnia appears to be independently associated with higher ICU mortality in patients with ARDS. Trial registration: Clinicaltrials.gov identifier, NCT01093482.",

keywords = "Acute respiratory distress syndrome, Hypercapnia, ICU mortality, Mechanical ventilation",

author = "Nicolas Nin and Alfonso Muriel and Oscar Pe{\~n}uelas and Laurent Brochard and Lorente, \{Jos{\'e} Angel\} and Ferguson, \{Niall D.\} and Konstantinos Raymondos and Fernando R{\'i}os and Violi, \{Damian A.\} and Thille, \{Arnaud W.\} and Marco Gonz{\'a}lez and Villagomez, \{Asisclo J.\} and Javier Hurtado and Davies, \{Andrew R.\} and Bin Du and Maggiore, \{Salvatore M.\} and Luis Soto and Gabriel D{\textquoteright}Empaire and Dimitrios Matamis and Fekri Abroug and Moreno, \{Rui P.\} and Soares, \{Marco Antonio\} and Yaseen Arabi and Freddy Sandi and Manuel Jibaja and Pravin Amin and Younsuck Koh and Kuiper, \{Michael A.\} and B{\"u}low, \{Hans Henrik\} and Zeggwagh, \{Amine Ali\} and Antonio Anzueto and Sznajder, \{Jacob I.\} and Andres Esteban and \{for the VENTILA Group\}, \{the VENTILA Group\}",

note = "Publisher Copyright: {\textcopyright} 2017, Springer-Verlag Berlin Heidelberg and ESICM.",

year = "2017",

month = feb,

day = "1",

doi = "10.1007/s00134-016-4611-1",

language = "Ingl{\'e}s",

volume = "43",

pages = "200--208",

journal = "Intensive Care Medicine",

issn = "0342-4642",

publisher = "Springer Science and Business Media Deutschland GmbH",

number = "2",

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Nin, N, Muriel, A, Peñuelas, O, Brochard, L, Lorente, JA, Ferguson, ND, Raymondos, K, Ríos, F, Violi, DA, Thille, AW, González, M, Villagomez, AJ, Hurtado, J, Davies, AR, Du, B, Maggiore, SM, Soto, L, D’Empaire, G, Matamis, D, Abroug, F, Moreno, RP, Soares, MA, Arabi, Y, Sandi, F, Jibaja, M, Amin, P, Koh, Y, Kuiper, MA, Bülow, HH, Zeggwagh, AA, Anzueto, A, Sznajder, JI, Esteban, A & for the VENTILA Group, TVENTILAG 2017, 'Severe hypercapnia and outcome of mechanically ventilated patients with moderate or severe acute respiratory distress syndrome', Intensive Care Medicine, vol. 43, no. 2, pp. 200-208. https://doi.org/10.1007/s00134-016-4611-1

TY - JOUR

T1 - Severe hypercapnia and outcome of mechanically ventilated patients with moderate or severe acute respiratory distress syndrome

AU - Nin, Nicolas

AU - Muriel, Alfonso

AU - Peñuelas, Oscar

AU - Brochard, Laurent

AU - Lorente, José Angel

AU - Ferguson, Niall D.

AU - Raymondos, Konstantinos

AU - Ríos, Fernando

AU - Violi, Damian A.

AU - Thille, Arnaud W.

AU - González, Marco

AU - Villagomez, Asisclo J.

AU - Hurtado, Javier

AU - Davies, Andrew R.

AU - Du, Bin

AU - Maggiore, Salvatore M.

AU - Soto, Luis

AU - D’Empaire, Gabriel

AU - Matamis, Dimitrios

AU - Abroug, Fekri

AU - Moreno, Rui P.

AU - Soares, Marco Antonio

AU - Arabi, Yaseen

AU - Sandi, Freddy

AU - Jibaja, Manuel

AU - Amin, Pravin

AU - Koh, Younsuck

AU - Kuiper, Michael A.

AU - Bülow, Hans Henrik

AU - Zeggwagh, Amine Ali

AU - Anzueto, Antonio

AU - Sznajder, Jacob I.

AU - Esteban, Andres

AU - for the VENTILA Group, the VENTILA Group

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Purpose: To analyze the relationship between hypercapnia developing within the first 48 h after the start of mechanical ventilation and outcome in patients with acute respiratory distress syndrome (ARDS). Patients and methods: We performed a secondary analysis of three prospective non-interventional cohort studies focusing on ARDS patients from 927 intensive care units (ICUs) in 40 countries. These patients received mechanical ventilation for more than 12 h during 1-month periods in 1998, 2004, and 2010. We used multivariable logistic regression and a propensity score analysis to examine the association between hypercapnia and ICU mortality. Main outcomes: We included 1899 patients with ARDS in this study. The relationship between maximum PaCO2 in the first 48 h and mortality suggests higher mortality at or above PaCO2 of ≥50 mmHg. Patients with severe hypercapnia (PaCO2 ≥50 mmHg) had higher complication rates, more organ failures, and worse outcomes. After adjusting for age, SAPS II score, respiratory rate, positive end-expiratory pressure, PaO2/FiO2 ratio, driving pressure, pressure/volume limitation strategy (PLS), corrected minute ventilation, and presence of acidosis, severe hypercapnia was associated with increased risk of ICU mortality [odds ratio (OR) 1.93, 95% confidence interval (CI) 1.32 to 2.81; p = 0.001]. In patients with severe hypercapnia matched for all other variables, ventilation with PLS was associated with higher ICU mortality (OR 1.58, CI 95% 1.04–2.41; p = 0.032). Conclusions: Severe hypercapnia appears to be independently associated with higher ICU mortality in patients with ARDS. Trial registration: Clinicaltrials.gov identifier, NCT01093482.

AB - Purpose: To analyze the relationship between hypercapnia developing within the first 48 h after the start of mechanical ventilation and outcome in patients with acute respiratory distress syndrome (ARDS). Patients and methods: We performed a secondary analysis of three prospective non-interventional cohort studies focusing on ARDS patients from 927 intensive care units (ICUs) in 40 countries. These patients received mechanical ventilation for more than 12 h during 1-month periods in 1998, 2004, and 2010. We used multivariable logistic regression and a propensity score analysis to examine the association between hypercapnia and ICU mortality. Main outcomes: We included 1899 patients with ARDS in this study. The relationship between maximum PaCO2 in the first 48 h and mortality suggests higher mortality at or above PaCO2 of ≥50 mmHg. Patients with severe hypercapnia (PaCO2 ≥50 mmHg) had higher complication rates, more organ failures, and worse outcomes. After adjusting for age, SAPS II score, respiratory rate, positive end-expiratory pressure, PaO2/FiO2 ratio, driving pressure, pressure/volume limitation strategy (PLS), corrected minute ventilation, and presence of acidosis, severe hypercapnia was associated with increased risk of ICU mortality [odds ratio (OR) 1.93, 95% confidence interval (CI) 1.32 to 2.81; p = 0.001]. In patients with severe hypercapnia matched for all other variables, ventilation with PLS was associated with higher ICU mortality (OR 1.58, CI 95% 1.04–2.41; p = 0.032). Conclusions: Severe hypercapnia appears to be independently associated with higher ICU mortality in patients with ARDS. Trial registration: Clinicaltrials.gov identifier, NCT01093482.

KW - Acute respiratory distress syndrome

KW - Hypercapnia

KW - ICU mortality

KW - Mechanical ventilation

UR - https://www.scopus.com/pages/publications/85009921453

U2 - 10.1007/s00134-016-4611-1

DO - 10.1007/s00134-016-4611-1

M3 - Artículo

C2 - 28108768

AN - SCOPUS:85009921453

SN - 0342-4642

VL - 43

SP - 200

EP - 208

JO - Intensive Care Medicine

JF - Intensive Care Medicine

IS - 2

ER -

Severe hypercapnia and outcome of mechanically ventilated patients with moderate or severe acute respiratory distress syndrome

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Keywords

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