Association of intraoperative end-tidal CO2 levels with postoperative outcomes: a patient-level analysis of two randomised clinical trials
- Autori: Prashant, N.; David M P, V.M.; Frederique, P.; Carlos, F.; Thomas, B.; Marcelo, G.D.A.; Lorenzo, B.; Sebastiaan M, B.; Patrick, S.; Marcus J, S.; Ary, S.N.; Sabrine N T, H.; S Campos, N.; Bluth, T.; T Hemmes, S.N.; Librero, J.; Pozo, N.; Ferrando, C.; Ball, L.; Mazzinari, G.; Pelosi, P.; Gama De Abreu, M.; J Schultz, M.; T Hemmes, A.S.N.S.N.; Gama De Abreu, M.; Severgnini, P.; W Hollmann, M.; M Binnekade, J.; Wrigge, H.; Canet, J.; Hiesmayr, M.; Schmid, W.; Tschernko, E.; Jaber, S.; Hedenstierna, G.; Putensen, C.; Pelosi, P.; J Schultz, M.; Marti, A.; Bacuzzi, A.; Brodhun, A.; Molin, A.; Merten, A.; Parera, A.; Brunelli, A.; Cortegiani, A.; Güldner, A.; W Reske, A.; Gratarola, A.; Giarratano, A.; Bastin, B.; Heyse, B.; Mazul-Sunko, B.; Amantea, B.; Barberis, B.; Putensen, C.; Uhlig, C.; Minguez MarÃn, C.; Celentano, C.; La Bella, D.; D'Antini, D.; Velghe, D.; Sulemanji, D.; De Robertis, E.; Hartmann, E.; Montalto, F.; Tropea, F.; H Mills, G.; Cinnella, G.; Della Rocca, G.; Caggianelli, G.; Pellerano, G.; Mollica, G.; Bugedo, G.; Wrigge, H.; Mulier, J.; Vandenbrande, J.; Geib, J.; Yaqub, J.; Florez, J.; F Mayoral, J.; Sprung, J.; Van Limmen, J.; J Bos, L.D.; De Baerdemaeker, L.; Jamaer, L.; Spagnolo, L.; Strys, L.; Granell Gil, M.; Gama De Abreu, M.; F Vidal Melo, M.; J Schultz, M.; Carmen Unzueta, M.; Victoria Moral, M.; Ferner, M.; W Hollmann, M.; Weiss, M.; Vanoni, M.; S Schaefer, M.; Prieto, M.; Grio, M.; Severgnini, P.; Markus Spieth, P.; Simon, P.; Bodger, P.; Sierra, P.; Laufenberg-Feldmann, R.; Rusca, R.; Proietti, R.; T Hemmes, S.N.; Raineri, S.M.; Caroleo, S.; Sabaté, S.; De Hert, S.; Pezzato, S.; A Treschan, T.; Goranovic, T.; Koch, T.; Bluth, T.; Kiss, T.; Perilli, V.; Cegarra, V.; Schmid Thomas Bluth, W.; Serpa Neto, A.; Bobek, I.; Canet, J.; Cinnella, G.; De Baerdemaeker, L.; Gregoretti, C.; Hedenstierna, G.; T Hemmes, S.N.; Hiesmayr, M.; W Hollmann, M.; Jaber, S.; Laffey, J.; Licker, M.; Markstaller, K.; Matot, I.; H Mills, G.; Paul Mulier, J.; Putensen, C.; Rossaint, R.; Schmitt, J.; Senturk, M.; Severgnini, P.; Sprung, J.; F Vidal Melo, M.; Wrigge, H.; J Schultz, M.; Pelosi, P.; Gama De Abreu, M.; Abelha, F.; AbitaÄŸaoÄŸlu, S.; Achilles, M.; Adebesin, A.; Adriaensens, I.; Ahene Fatima Akbar, C.; Al Harbi, M.; Al Khoury Al Kallab, R.; Albanel, X.; Aldenkortt, F.; Abdullah Saleh Alfouzan, R.; Alruqaie, R.; Altermatt, F.; LuÃs De Castro Araujo, B.; Genaro, A.; Artsi, H.; Aurilio Omer Hilmi Ayanoglu, C.; Bacuzzi, A.; Baig, H.; Baird, Y.; Balonov Jaume Balust, K.; Banks, S.; Bao, X.; Baumgartner, M.; Belda Tortosa, I.; Bergamaschi, A.; Bergmann, L.; Bigatello, L.; Biosca Pérez, E.; Birr, K.; Bluth, T.; Bojaxhi, E.; Bonenti, C.; Bonney, I.; E Bos, E.M.; Bowman, S.; Gobbo Braz, L.; Brugnoni, E.; J Brull, S.; Brunetti, I.; Bruni, A.; L Buenvenida, S.; Johannes Busch, C.; Camerini, G.; Canet, J.; 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.; Davies, S.; De Baerdemaeker, L.; De Hert, S.; Del Cojo Peces, E.; Delphin, E.; Diaper, J.; Do Nascimento Junior, P.; Donatiello, V.; Dong, J.; Do Socorro Dourado, M.; Dullenkopf, A.; Ebner, F.; Elgendy, H.; Ellenberger, C.; ErdoÄŸan Arı, D.; Ermert, T.; Farah, F.; Fernandez-Bustamante, A.; Ferreira, C.; Fiore, M.; Fonte, A.; Fortià PalahÃ, C.; Galimberti, A.; Gama De Abreu, M.; Garofano, N.; Gregorio Giaccari, L.; Gilsanz, F.; Girrbach, F.; Gobbi, L.; Bernard Godfried, M.; Goettel, N.; A Goldstein, P.; Goren, O.; Gorlin, A.; Gil Manuel, G.; Gratarola, A.; Graterol, J.; Guyon, P.; Haire, K.; Harou, P.; Helf, A.; T Hemmes, S.N.; Hempel, G.; José Hernández Cádiz, M.; Heyse, B.; W Hollmann, M.; Huercio, I.; Ilievska, J.; Jakus, L.; Jeganath, V.; Jelting, Y.; Jung, M.; Kabon, B.; Kacha, A.; Karaman Ilić, M.; Karuppiah, A.; Duygu Kavas, A.; Keli Barcelos, G.; A Kellogg, T.; Kemper, J.
- Anno di pubblicazione: 2025
- Tipologia: Articolo in rivista
- OA Link: http://hdl.handle.net/10447/709460
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.