Association of intraoperative end-tidal CO2 levels with postoperative outcomes: a patient-level analysis of two randomised clinical trials

Fecha de publicación:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Nasa P.
  • van Meenen D.M.P.
  • Paulus F.
  • Ferrando C.
  • Bluth T.
  • de Abreu M.G.
  • Ball L.
  • Bossers S.M.
  • Schober P.
  • Schultz M.J.
  • Neto A.S.
  • Hemmes S.N.T.
  • Campos N.S.
  • Pozo N.
  • Severgnini P.
  • Hollmann M.W.
  • Binnekade J.M.
  • Wrigge H.
  • Canet J.
  • Hiesmayr M.
  • Schmid W.
  • Tschernko E.
  • Jaber S.
  • Hedenstierna G.
  • Putensen C.
  • Marti A.
  • Bacuzzi A.
  • Brodhun A.
  • Molin A.
  • Merten A.
  • Parera A.
  • Brunelli A.
  • Cortegiani A.
  • Güldner A.
  • Reske A.W.
  • Gratarola A.
  • Giarratano A.
  • Bastin B.
  • Heyse B.
  • Mazul-Sunko B.
  • Amantea B.
  • Barberis B.
  • Uhlig C.
  • Marín C.M.
  • Celentano C.
  • La Bella D.
  • D'Antini D.
  • Velghe D.
  • Sulemanji D.
  • De Robertis E.
  • Hartmann E.
  • Montalto F.
  • Tropea F.
  • Mills G.H.
  • Cinnella G.
  • Della Rocca G.
  • Caggianelli G.
  • Pellerano G.
  • Mollica G.
  • Bugedo G.
  • Mulier J.-P.
  • Vandenbrande J.
  • Geib J.
  • Yaqub J.
  • Florez J.
  • Mayoral J.F.
  • Sprung J.
  • Van Limmen J.
  • Bos L.D.J.
  • de Baerdemaeker L.
  • Jamaer L.
  • Spagnolo L.
  • Strys L.
  • Gil M.G.
  • Unzueta M.C.
  • Moral M.V.
  • Ferner M.
  • Weiss M.
  • Vanoni M.
  • Schaefer M.S.
  • Prieto M.
  • Grio M.
  • Spieth P.M.
  • Simon P.
  • Bodger P.
  • Sierra P.
  • Laufenberg-Feldmann R.
  • Rusca R.
  • Proietti R.
  • Raineri S.M.
  • Caroleo S.
  • Sabaté S.
  • De Hert S.
  • Pezzato S.
  • Treschan T.A.
  • Goranovic T.
  • Koch T.
  • Kiss T.
  • Perilli V.
  • Belda J.
  • Soro M.
  • Unzueta C.
  • Suarez-Sipmann F.
  • Librero J.
  • Llombart A.
  • Rovira L.
  • Granell M.
  • Aldecoa C.
  • Diaz-Cambronero O.
  • Balust J.
  • Garutti I.
  • Gonzalez R.
  • Gallego L.
  • del Valle S.G.
  • Redondo J.
  • Pestaña D.
  • Rodríguez A.
  • García J.
  • de la Matta M.
  • Ibáñez M.
  • Barrios F.
  • Hernández S.
  • Torres V.
  • Peiró S.
  • Villena A.
  • Carramiñana A.
  • Gallego-Casilda A.
  • Duca A.
  • Alcón A.
  • Miñana A.
  • Asensio A.
  • Colás A.
  • Galve A.I.
  • Izquierdo A.
  • Jurado A.
  • Pérez A.M.
  • Mugarra A.
  • Gutierrez A.
  • De Miguel Á.
  • Lozano A.
  • Katime A.
  • Romero A.
  • Garrigues B.
  • Ayas B.
  • Arocas B.
  • Delgado C.
  • Fernández C.
  • Romero C.
  • Gallego C.
  • Garcés C.
  • Lisbona C.
  • Parrilla C.
  • López-Herrera D.
  • González D.
  • Llamazares E.
  • Del Rio E.
  • Lozano E.
  • Pastor E.
  • Chamorro E.
  • Gracia E.
  • Sánchez E.
  • Romero E.
  • Díez F.
  • Serralta F.
  • Daviu F.
  • Sandín F.
  • Aguilar G.
  • Tusman G.
  • Azparren G.
  • Martínez-Pallí G.
  • Benítez I.
  • Hernandéz I.
  • India I.
  • León I.
  • Fuentes I.
  • Ruiz I.
  • Puig J.
  • Román J.I.
  • Acosta J.
  • Rico-Feijoo J.
  • Olmedo J.
  • Carbonell J.A.
  • Alonso J.M.
  • Pérez J.M.
  • Marcos J.M.
  • Navarro J.
  • Valdivia J.
  • Carrizo J.
  • Piqueras L.
  • Soriano L.
  • Vaquero L.
  • Miguel L.
  • Muñoz L.
  • Valencia L.
  • Olmedilla L.
  • Etulain M.J.
  • Tisner M.
  • Barrio M.
  • Alonso M.D.
  • Hernández M.J.
  • Alberola M.J.
  • Parra M.
  • Argente M.P.
  • Vila M.
  • De Fez M.
  • Agilaga M.
  • Gine M.
  • Ayuso M.
  • García M.
  • Bejarano N.
  • Peña N.
  • Ojeda N.
  • Martínez N.
  • García N.
  • Padrón O.
  • García P.
  • Valls P.
  • Cruz P.
  • Piñeiro P.
  • Charco P.
  • Anaya R.
  • López R.
  • Rodríguez R.
  • Martínez R.
  • Pujol R.
  • Dosdá R.
  • Lardies R.
  • Díaz R.
  • Villazala R.
  • Zapatero S.
  • Cabrera S.
  • Sánchez S.
  • Martin S.
  • Diaz S.
  • Franco T.
  • Moreno T.
  • Socorro T.
  • Gilabert V.
  • Balandrón V.
  • Moral V.
  • Cegarra V.
  • Varón V.
  • Bobek I.
  • Gregoretti C.
  • Laffey J.
  • Licker M.-J.
  • Markstaller K.
  • Matot I.
  • Mulier J.P.
  • Rossaint R.
  • Schmitt J.
  • Senturk M.
  • Pelosi P.
  • Abelha F.
  • Abitagaoglu S.
  • Achilles M.
  • Adebesin A.
  • Adriaensens I.
  • Ahene C.
  • Akbar F.
  • Al Harbi M.
  • Al Khoury al Kallab R.
  • Albanel X.
  • Aldenkortt F.
  • Alfouzan R.A.
  • Saleh Alruqaie R.
  • Altermatt F.
  • Araujo B.L.D.C.
  • Arbesú G.
  • Artsi H.
  • Aurilio C.
  • Ayanoglu O.H.
  • Baig H.
  • Baird Y.
  • Balonov K.
  • Banks S.
  • Bao X.
  • Baumgartner M.
  • Belda Tortosa I.
  • Bergamaschi A.
  • Bergmann L.
  • Bigatello L.
  • Biosca Pérez E.
  • Birr K.
  • Bojaxhi E.
  • Bonenti C.
  • Bonney I.
  • Bos E.M.E.
  • Bowman S.
  • Braz L.G.
  • Brugnoni E.
  • Brull S.J.
  • Brunetti I.
  • Bruni A.
  • Buenvenida S.L.
  • Busch C.J.
  • Camerini G.
  • Capatti B.
  • Carmona J.
  • Carungcong J.
  • Carvalho M.
  • Cattan A.
  • Cavaleiro C.
  • Chiumello D.
  • Ciardo S.
  • Coburn M.
  • Colella U.
  • Contreras V.
  • Corman Dincer P.
  • Cotter E.
  • Crovetto M.
  • Darrah W.
  • Del Cojo Peces E.
  • Delphin E.
  • Diaper J.
  • do Nascimento P., Junior
  • Donatiello V.
  • Dong J.
  • Dourado M.D.S.
  • Dullenkopf A.
  • Ebner F.
  • Elgendy H.
  • Ellenberger C.
  • Erdogan Ari D.
  • Ermert T.
  • Farah F.
  • Fernandez-Bustamante A.
  • Ferreira C.
  • Fiore M.
  • Fonte A.
  • Fortià Palahí C.
  • Galimberti A.
  • Gama de Abreu M.
  • Garofano N.
  • Giaccari L.G.
  • Gilsanz F.
  • Girrbach F.
  • Gobbi L.
  • Godfried M.B.
  • Goettel N.
  • Goldstein P.A.
  • Goren O.
  • Gorlin A.
  • Granell Gil M.
  • Graterol J.
  • Guyon P.
  • Haire K.
  • Harou P.
  • Helf A.
  • Hempel G.
  • Hernández Cádiz M.J.
  • Huercio I.
  • Ilievska J.
  • Jakus L.
  • Jeganath V.
  • Jelting Y.
  • Jung M.
  • Kabon B.
  • Kacha A.
  • Karaman Ilic M.
  • Karuppiah A.
  • Kavas A.D.
  • Keli Barcelos G.
  • Kellogg T.A.
  • Kemper J.
  • Kerbrat R.
  • Khodr S.
  • Kienbaum P.
  • Kir B.
  • Kivrak S.
  • Klaric V.
  • Köksal C.
  • Kowark A.
  • Kranke P.
  • Kuvaki B.
  • Kuzmanovska B.
  • Lange M.
  • Lemos M.F.D.
  • López-Baamonde M.
  • López-Hernández A.
  • Lopez-Martinez M.
  • Luise S.
  • MacGregor M.
  • Magalhães D.
  • Maillard J.
  • Malerbi P.
  • Manimekalai N.
  • Margarson M.
  • Martin A.K.
  • Martin D.P.
  • Martin Y.N.
  • Martínez-Ocon J.
  • Martin-Loeches I.
  • Maseda E.
  • McAuliffe N.
  • McKenzie T.J.
  • Medina P.
  • Meersch M.
  • Menzen A.
  • Mertens E.
  • Meurer B.
  • Meyer-Treschan T.
  • Miao C.
  • Micalizzi C.
  • Milic M.
  • Módolo N.S.P.
  • Moine P.
  • Mölders P.
  • Montero-Feijoo A.
  • Moret E.
  • Muller M.K.
  • Murphy Z.
  • Nalwaya P.
  • Naumovski F.
  • Navalesi P.
  • Navarro e Lima L.H.
  • Nesek Adam V.
  • Neumann C.
  • Newell C.
  • Nisnevitch Z.
  • Nizamuddin J.
  • Novazzi C.
  • O'Connor M.
  • Oprea G.
  • Orhan Sungur M.
  • Özbilgin S.
  • Pace M.C.
  • Pacheco M.
  • Packianathaswamy B.
  • Palma Gonzalez E.
  • Papaspyros F.
  • Paredes S.
  • Passavanti M.B.
  • Pedemonte J.C.
  • Peremin S.
  • Philipsenburg C.
  • Pinho D.
  • Pinho S.
  • Posthuma L.M.
  • Pota V.
  • Preckel B.
  • Priani P.
  • Rached M.A.
  • Radoeshki A.
  • Ragazzi R.
  • Rajamanickam T.
  • Rajamohan A.
  • Ramakrishna H.
  • Rangarajan D.
  • Reiterer C.
  • Renew J.R.
  • Reynaud T.
  • Rhys R.
  • Rivas E.
  • Robitzky L.
  • Rubulotta F.
  • Machado S.H.
  • Nunes S.C.
  • Sabbatini G.
  • Samuels J.D.
  • Sanahuja J.M.
  • Sansone P.
  • Santos A.
  • Sayedalahl M.
  • Scharffenberg M.
  • Schiffer E.
  • Schliewe N.
  • Schorer R.
  • Schumann R.
  • Selmo G.
  • Sendra M.
  • Shaw K.
  • Shosholcheva M.
  • Sibai A.
  • Simonassi F.
  • Sinno C.
  • Sivrikoz N.
  • Skandalou V.
  • Smith N.
  • Soares M.
  • Socorro Artiles T.
  • Sousa Castro D.
  • Sousa M.
  • Spadaro S.
  • Stamatakis E.
  • Steiner L.A.
  • Stevenazzi A.
  • Suarez-De-la-Rica A.
  • Suppan M.
  • Teichmann R.
  • Tena Guerrero J.M.
  • Thiel B.
  • Tolós R.
  • Tore Altun G.
  • Tucci M.
  • Turnbull Z.A.
  • Turudic Ž.
  • Unterberg M.
  • Van Nieuwenhove Y.
  • Van Waesberghe J.
  • Vidal Melo M.F.
  • Vitkovic B.
  • Vivona L.
  • Vizcaychipi M.
  • Volta C.A.
  • Weber A.
  • Weingarten T.N.
  • Wittenstein J.
  • Wyffels P.
  • Yagüe J.
  • Yates D.
  • Yavru A.
  • Zac L.
  • Zhong J.

Grupos

Abstract

Background: The relationship between intraoperative end-tidal CO2 (etCO2) levels and postoperative outcomes remains unclear. We conducted a post hoc analysis of two randomised trials in adults undergoing major surgery under general anaesthesia. Methods: We re-analysed individual participant data comparing high or low positive end-expiratory pressure with low tidal volume intraoperative ventilation using a merged database derived from two randomised trials in non-obese (PROVHILO: ISRCTN70332574) and obese (PROBESE: NCT02148692) patients. The exposure of interest was low etCO2 (<4.7 kPa) vs normal-high etCO2 (=4.7 kPa). The primary outcome was postoperative pulmonary complications within 5 days. A time-weighted etCO2 analysis and propensity score matching were also performed to adjust for confounding. Results: Of 2793 participants, 891 (29.4%; 52% female) had low etCO2, compared with 1972/2793 (70.6%; 65% female) participants with normal-high etCO2. Compared with participants with normal-high etCO2, higher minute volumes (normalised to body weight) were delivered in participants with low etCO2. Postoperative pulmonary complications developed in 278/821 (34%) participants with low etCO2, compared with 462/1972 (23%) participants who had normal-high etCO2 (adjusted hazard ratio, 1.3; 95% confidence interval, 1.1-1.6; P<0.001). The time-weighted analysis showed an inverse linear relationship between the mean etCO2 and postoperative pulmonary complications, which was also confirmed by propensity matching. Conclusions: Low etCO2 occurs often during intraoperative ventilation and is associated with a higher rate of PPCs. The etCO2 level has an inverse dose-dependent relationship with postoperative pulmonary complications. Clinical trial registration: NCT05550181. © 2025 The Author(s)

Datos de la publicación

ISSN/ISSNe:
0007-0912, 1471-6771

BRITISH JOURNAL OF ANAESTHESIA  ELSEVIER SCI LTD

Tipo:
Article
Páginas:
1761-1769
PubMed:
40930872
Enlace a otro recurso:
www.scopus.com
Factor de Impacto:
2,642 SCImago ℠
Cuartil:
Q1 SCImago ℠

Documentos

  • No hay documentos

Métricas

Filiaciones mostrar / ocultar

Keywords

  • Adult; Aged; Anesthesia, General; Carbon Dioxide; Female; Humans; Lung Diseases; Male; Middle Aged; Positive-Pressure Respiration; Postoperative Complications; Randomized Controlled Trials as Topic; Tidal Volume; Treatment Outcome; carbon dioxide; adult; Article; body weight; clinical outcome; controlled study; end tidal carbon dioxide tension; female; general anesthesia; human; intraoperative period; major clinical study; major surgery; male; outcome assessment; positive end expiratory pressure ventilation; post hoc analysis; postoperative lung complication; propensity score; sensitivity analysis; tidal volume; aged; epidemiology; etiology; general anesthesia; lung disease; metabolism; middle aged; physiology; positive pressure ventilation; postoperative complication; procedures; randomized controlled trial; randomized controlled trial (topic); treatment outcome

Cita

Compartir