Clinical practice and effect of carbon dioxide on outcomes in mechanically ventilated acute brain-injured patients : a secondary analysis of the ENIO study
© 2024. The Author(s)..
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.
| Errataetall: |
ErratumIn: Intensive Care Med. 2024 Feb 23;:. - PMID 38393334 |
|---|---|
| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:50 |
|---|---|
| Enthalten in: |
Intensive care medicine - 50(2024), 2 vom: 29. Feb., Seite 234-246 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Robba, Chiara [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
142M471B3J |
|---|
| Anmerkungen: |
Date Completed 04.03.2024 Date Revised 04.03.2024 published: Print-Electronic ErratumIn: Intensive Care Med. 2024 Feb 23;:. - PMID 38393334 Citation Status MEDLINE |
|---|
| doi: |
10.1007/s00134-023-07305-3 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM367848406 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM367848406 | ||
| 003 | DE-627 | ||
| 005 | 20240304232358.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240131s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1007/s00134-023-07305-3 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1316.xml |
| 035 | |a (DE-627)NLM367848406 | ||
| 035 | |a (NLM)38294526 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Robba, Chiara |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Clinical practice and effect of carbon dioxide on outcomes in mechanically ventilated acute brain-injured patients |b a secondary analysis of the ENIO study |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 04.03.2024 | ||
| 500 | |a Date Revised 04.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ErratumIn: Intensive Care Med. 2024 Feb 23;:. - PMID 38393334 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2024. The Author(s). | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Brain injury | |
| 650 | 4 | |a Carbon dioxide | |
| 650 | 4 | |a Critical care | |
| 650 | 4 | |a Hyperventilation | |
| 650 | 4 | |a ICH | |
| 650 | 4 | |a Intensive care | |
| 650 | 4 | |a Invasive ventilation | |
| 650 | 4 | |a PaCO2 | |
| 650 | 4 | |a SAH | |
| 650 | 4 | |a Stroke | |
| 650 | 4 | |a TBI | |
| 650 | 7 | |a Carbon Dioxide |2 NLM | |
| 650 | 7 | |a 142M471B3J |2 NLM | |
| 700 | 1 | |a Battaglini, Denise |e verfasserin |4 aut | |
| 700 | 1 | |a Abbas, Abbas |e verfasserin |4 aut | |
| 700 | 1 | |a Sarrió, Ezequiel |e verfasserin |4 aut | |
| 700 | 1 | |a Cinotti, Raphael |e verfasserin |4 aut | |
| 700 | 1 | |a Asehnoune, Karim |e verfasserin |4 aut | |
| 700 | 1 | |a Taccone, Fabio S |e verfasserin |4 aut | |
| 700 | 1 | |a Rocco, Patricia R |e verfasserin |4 aut | |
| 700 | 1 | |a Schultz, Marcus J |e verfasserin |4 aut | |
| 700 | 1 | |a Citerio, Giuseppe |e verfasserin |4 aut | |
| 700 | 1 | |a Stevens, Robert David |e verfasserin |4 aut | |
| 700 | 1 | |a Badenes, Rafael |e verfasserin |4 aut | |
| 700 | 0 | |a ENIO collaborators |e verfasserin |4 aut | |
| 700 | 1 | |a Abback, Paër-Sélim |e investigator |4 oth | |
| 700 | 1 | |a Codorniu, Anaïs |e investigator |4 oth | |
| 700 | 1 | |a Citerio, Giuseppe |e investigator |4 oth | |
| 700 | 1 | |a Sala, Vittoria Ludovica |e investigator |4 oth | |
| 700 | 1 | |a Astuto, Marinella |e investigator |4 oth | |
| 700 | 1 | |a Tringali, Eleonora |e investigator |4 oth | |
| 700 | 1 | |a Alampi, Daniela |e investigator |4 oth | |
| 700 | 1 | |a Rocco, Monica |e investigator |4 oth | |
| 700 | 1 | |a Maugeri, Jessica Giuseppina |e investigator |4 oth | |
| 700 | 1 | |a Bellissima, Agrippino |e investigator |4 oth | |
| 700 | 1 | |a Filippini, Matteo |e investigator |4 oth | |
| 700 | 1 | |a Lazzeri, Nicoletta |e investigator |4 oth | |
| 700 | 1 | |a Cortegiani, Andrea |e investigator |4 oth | |
| 700 | 1 | |a Ippolito, Mariachiara |e investigator |4 oth | |
| 700 | 1 | |a Robba, Chiara |e investigator |4 oth | |
| 700 | 1 | |a Battaglini, Denise |e investigator |4 oth | |
| 700 | 1 | |a Biston, Patrick |e investigator |4 oth | |
| 700 | 1 | |a Al-Gharyani, Mohamed Fathi |e investigator |4 oth | |
| 700 | 1 | |a Chabanne, Russell |e investigator |4 oth | |
| 700 | 1 | |a Astier, Léo |e investigator |4 oth | |
| 700 | 1 | |a Soyer, Benjamin |e investigator |4 oth | |
| 700 | 1 | |a Gaugain, Samuel |e investigator |4 oth | |
| 700 | 1 | |a Zimmerli, Alice |e investigator |4 oth | |
| 700 | 1 | |a Pietsch, Urs |e investigator |4 oth | |
| 700 | 1 | |a Filipovic, Miodrag |e investigator |4 oth | |
| 700 | 1 | |a Brandi, Giovanna |e investigator |4 oth | |
| 700 | 1 | |a Bicciato, Giulio |e investigator |4 oth | |
| 700 | 1 | |a Serrano, Ainhoa |e investigator |4 oth | |
| 700 | 1 | |a Monleon, Berta |e investigator |4 oth | |
| 700 | 1 | |a van Vliet, Peter |e investigator |4 oth | |
| 700 | 1 | |a Gerretsen, Benjamin Marcel |e investigator |4 oth | |
| 700 | 1 | |a Ortiz-Macias, Iris Xochitl |e investigator |4 oth | |
| 700 | 1 | |a Oto, Jun |e investigator |4 oth | |
| 700 | 1 | |a Enomoto, Noriya |e investigator |4 oth | |
| 700 | 1 | |a Matsuda, Tomomichi |e investigator |4 oth | |
| 700 | 1 | |a Masui, Nobutaka |e investigator |4 oth | |
| 700 | 1 | |a Garçon, Pierre |e investigator |4 oth | |
| 700 | 1 | |a Zarka, Jonathan |e investigator |4 oth | |
| 700 | 1 | |a Vermeijden, Wytze J |e investigator |4 oth | |
| 700 | 1 | |a Cornet, Alexander Daniel |e investigator |4 oth | |
| 700 | 1 | |a Gard, Sergio Reyes Infra |e investigator |4 oth | |
| 700 | 1 | |a Domínguez, Rafael Cirino Lara |e investigator |4 oth | |
| 700 | 1 | |a Bellini, Maria Mercedes |e investigator |4 oth | |
| 700 | 1 | |a Haedo, Maria Milagros Gomez |e investigator |4 oth | |
| 700 | 1 | |a Lamot, Laura |e investigator |4 oth | |
| 700 | 1 | |a Orquera, Jose |e investigator |4 oth | |
| 700 | 1 | |a Biais, Matthieu |e investigator |4 oth | |
| 700 | 1 | |a Georges, Delphine |e investigator |4 oth | |
| 700 | 1 | |a Baronial, Arvind |e investigator |4 oth | |
| 700 | 1 | |a Miranda-Ackerman, Roberto Carlos |e investigator |4 oth | |
| 700 | 1 | |a Barbosa-Camacho, Francisco José |e investigator |4 oth | |
| 700 | 1 | |a Porter, John |e investigator |4 oth | |
| 700 | 1 | |a Lopez-Morales, Miguel |e investigator |4 oth | |
| 700 | 1 | |a Geeraerts, Thomas |e investigator |4 oth | |
| 700 | 1 | |a Companion, Baptiste |e investigator |4 oth | |
| 700 | 1 | |a Pérez-Torres, David |e investigator |4 oth | |
| 700 | 1 | |a Prol-Silva, Estefanía |e investigator |4 oth | |
| 700 | 1 | |a Yahya, Hana Basheer |e investigator |4 oth | |
| 700 | 1 | |a Khaled, Ala |e investigator |4 oth | |
| 700 | 1 | |a Ghulam, Mohamed |e investigator |4 oth | |
| 700 | 1 | |a Andrea, Cracchiolo Neville |e investigator |4 oth | |
| 700 | 1 | |a Daniela, Palma Maria |e investigator |4 oth | |
| 700 | 1 | |a Deana, Cristian |e investigator |4 oth | |
| 700 | 1 | |a Vetrugno, Luigi |e investigator |4 oth | |
| 700 | 1 | |a Chavez, Manuel J Rivera |e investigator |4 oth | |
| 700 | 1 | |a Trujillo, Rocio Mendoza |e investigator |4 oth | |
| 700 | 1 | |a Legros, Vincent |e investigator |4 oth | |
| 700 | 1 | |a Brochet, Benjamin |e investigator |4 oth | |
| 700 | 1 | |a Huet, Olivier |e investigator |4 oth | |
| 700 | 1 | |a Geslain, Marie |e investigator |4 oth | |
| 700 | 1 | |a van der Jagt, Mathieu |e investigator |4 oth | |
| 700 | 1 | |a van Steenkiste, Job |e investigator |4 oth | |
| 700 | 1 | |a Ahmed, Hazem |e investigator |4 oth | |
| 700 | 1 | |a Coombs, Alexander Edward |e investigator |4 oth | |
| 700 | 1 | |a Welbourne, Jessie |e investigator |4 oth | |
| 700 | 1 | |a Pineda, Ana Alicia Velarde |e investigator |4 oth | |
| 700 | 1 | |a Castillo, Víctor Hugo Nubert |e investigator |4 oth | |
| 700 | 1 | |a Azab, Mohammed A |e investigator |4 oth | |
| 700 | 1 | |a Azzam, Ahmed Y |e investigator |4 oth | |
| 700 | 1 | |a van Meenen, David Michael Paul |e investigator |4 oth | |
| 700 | 1 | |a Gasca, Gilberto Adrian |e investigator |4 oth | |
| 700 | 1 | |a Arellano, Alfredo |e investigator |4 oth | |
| 700 | 1 | |a Galicia-Espinosa, Forttino |e investigator |4 oth | |
| 700 | 1 | |a García-Ramos, José Carlos |e investigator |4 oth | |
| 700 | 1 | |a Yadav, Ghanshyam |e investigator |4 oth | |
| 700 | 1 | |a Jha, Amarendra Kumar |e investigator |4 oth | |
| 700 | 1 | |a Robert-Edan, Vincent |e investigator |4 oth | |
| 700 | 1 | |a Rodie-Talbere, Pierre-Andre |e investigator |4 oth | |
| 700 | 1 | |a Jain, Gaurav |e investigator |4 oth | |
| 700 | 1 | |a Panda, Sagarika |e investigator |4 oth | |
| 700 | 1 | |a Agarwal, Sonika |e investigator |4 oth | |
| 700 | 1 | |a Deewan, Yashbir |e investigator |4 oth | |
| 700 | 1 | |a Gasca, Gilberto Adrian |e investigator |4 oth | |
| 700 | 1 | |a Arellano, Alfredo |e investigator |4 oth | |
| 700 | 1 | |a Reza, Syed Tariq |e investigator |4 oth | |
| 700 | 1 | |a Hossain, Md Mozaffer |e investigator |4 oth | |
| 700 | 1 | |a Papadas, Christos |e investigator |4 oth | |
| 700 | 1 | |a Chantziara, Vasiliki |e investigator |4 oth | |
| 700 | 1 | |a Sklavou, Chrysanthi |e investigator |4 oth | |
| 700 | 1 | |a Hourmant, Yannick |e investigator |4 oth | |
| 773 | 0 | 8 | |i Enthalten in |t Intensive care medicine |d 1993 |g 50(2024), 2 vom: 29. Feb., Seite 234-246 |w (DE-627)NLM000234818 |x 1432-1238 |7 nnns |
| 773 | 1 | 8 | |g volume:50 |g year:2024 |g number:2 |g day:29 |g month:02 |g pages:234-246 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1007/s00134-023-07305-3 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 50 |j 2024 |e 2 |b 29 |c 02 |h 234-246 | ||