Intraoperative end-tidal carbon dioxide and postoperative mortality in major abdominal surgery: a historical cohort study.

Tytuł:: Intraoperative end-tidal carbon dioxide and postoperative mortality in major abdominal surgery: a historical cohort study.
Autorzy:: Dong L; Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.; Department of Anesthesia, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Kyoto, 606-8507, Japan.
Takeda C; Department of Anesthesia, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Kyoto, 606-8507, Japan.
Yamazaki H; Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Kamitani T; Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
Kimachi M; Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
Hamada M; Department of Anesthesia, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Kyoto, 606-8507, Japan.
Fukuhara S; Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Mizota T; Department of Anesthesia, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Kyoto, 606-8507, Japan. .
Yamamoto Y; Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
Transliterated Title:: Dioxyde de carbone télé-expiratoire peropératoire et mortalité postopératoire en chirurgie abdominale majeure : une étude de cohorte historique.
Źródło:: Canadian journal of anaesthesia = Journal canadien d'anesthesie [Can J Anaesth] 2021 Nov; Vol. 68 (11), pp. 1601-1610. Date of Electronic Publication: 2021 Aug 06.
Typ publikacji:: Journal Article; Research Support, Non-U.S. Gov't
Język:: English
Imprint Name(s):: Publication: New York : Springer New York
Original Publication: [Toronto, Ont.] : Canadian Anaesthetists' Society, [c1987-
MeSH Terms:: Anesthesia, General*
Carbon Dioxide*
Cohort Studies ; Humans ; Postoperative Period ; Retrospective Studies
References:: Nepogodiev D, Martin J, Biccard B, et al. Global burden of postoperative death. Lancet 2019; DOI: https://doi.org/10.1016/S0140-6736(18)33139-8 . (PMID: 10.1016/S0140-6736(18)33139-831258122)
Merry AF, Cooper JB, Soyannwo O, Wilson IH, Eichhorn JH. International Standards for a Safe Practice of Anesthesia 2010. Can J Anesth 2010; 57: 1027-34. (PMID: 10.1007/s12630-010-9381-6)
Way M, Hill GE. Intraoperative end-tidal carbon dioxide concentrations: what is the target? Anesthesiol Res Pract 2011; DOI: https://doi.org/10.1155/2011/271539 . (PMID: 10.1155/2011/271539221104963202118)
Pinsky MR. Cardiovascular effects of ventilatory support and withdrawal. Anesth Analg 1994; 79: 567-76. (PMID: 10.1213/00000539-199409000-00029)
Lele EE, Hantos Z, Bitay M, et al. Bronchoconstriction during alveolar hypocapnia and systemic hypercapnia in dogs with a cardiopulmonary bypass. Respir Physiol Neurobiol 2011; 175: 140-5. (PMID: 10.1016/j.resp.2010.10.004)
Enoki T, Tsuchiya N, Shinomura T, Nomura R, Fukuda K. Effect of hypercapnia on arterial hypotension after induction of anaesthesia. Acta Anaesthesiol Scand 2005; 49: 687-91. (PMID: 10.1111/j.1399-6576.2005.00681.x)
Fleischmann E, Herbst F, Kugener A, et al. Mild hypercapnia increases subcutaneous and colonic oxygen tension in patients given 80% inspired oxygen during abdominal surgery. Anesthesiology 2006; 104: 944-9. (PMID: 10.1097/00000542-200605000-00009)
Contreras M, Ansari B, Curley G, et al. Hypercapnic acidosis attenuates ventilation-induced lung injury by a nuclear factor-kappaB-dependent mechanism. Crit Care Med 2012; 40: 2622-30. (PMID: 10.1097/CCM.0b013e318258f8b4)
Amato MB, Barbas CS, Medeiros DM, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 1998; 338: 347-54. (PMID: 10.1056/NEJM199802053380602)
Akkermans A, van Waes JA, Peelen LM, Rinkel GJ, van Klei WA. Blood pressure and end-tidal carbon dioxide ranges during aneurysm occlusion and neurologic outcome after an aneurysmal subarachnoid hemorrhage. Anesthesiology 2019; 130: 92-105. (PMID: 10.1097/ALN.0000000000002482)
Muizelaar JP, Marmarou A, Ward JD, et al. Adverse effects of prolonged hyperventilation in patients with severe head injury: a randomized clinical trial. J Neurosurg 1991; 75: 731-9. (PMID: 10.3171/jns.1991.75.5.0731)
Nin N, Muriel A, Peñuelas O, et al. Severe hypercapnia and outcome of mechanically ventilated patients with moderate or severe acute respiratory distress syndrome. Intensive Care Med 2017; 43: 200-8. (PMID: 10.1007/s00134-016-4611-1)
Akkermans A, van Waes JA, Thompson A, et al. An observational study of end-tidal carbon dioxide trends in general anesthesia. Can J Anesth 2019; 66: 149-60. (PMID: 10.1007/s12630-018-1249-1)
Dony P, Dramaix M, Boogaerts JG. Hypocapnia measured by end-tidal carbon dioxide tension during anesthesia is associated with increased 30-day mortality rate. J Clin Anesth 2017; 36: 123-6. (PMID: 10.1016/j.jclinane.2016.10.028)
Wax DB, Lin HM, Hossain S, Porter SB. Intraoperative carbon dioxide management and outcomes. Eur J Anaesthesiol 2010; 27: 819-23. (PMID: 10.1097/EJA.0b013e32833cca07)
Park JH, Lee HM, Kang CM, et al. Correlation of intraoperative end-tidal carbon dioxide concentration on postoperative hospital stay in patients undergoing pylorus-preserving pancreaticoduodenectomy. World J Surg 2021; DOI: https://doi.org/10.1007/s00268-021-05984-x . (PMID: 10.1007/s00268-021-05984-x343655327885757)
Mizota T, Dong L, Takeda C, et al. Invasive respiratory or vasopressor support and/or death as a proposed composite outcome measure for perioperative care research. Anesth Analg 2019; 129: 679-85. (PMID: 10.1213/ANE.0000000000003921)
Mizota T, Dong L, Takeda C, et al. Transient acute kidney injury after major abdominal surgery increases chronic kidney disease risk and 1-year mortality. J Crit Care 2019; 50: 17-22. (PMID: 10.1016/j.jcrc.2018.11.008)
Bryant AS, Rudemiller K, Cerfolio RJ. The 30- versus 90-day operative mortality after pulmonary resection. Ann Thorac Surg 2010; 89: 1717-23. (PMID: 10.1016/j.athoracsur.2010.01.069)
Joung RH, Merkow RP. Is it time to abandon 30-day mortality as a quality measure? Ann Surg Oncol 2021; 28: 1263-4. (PMID: 10.1245/s10434-020-09262-3)
Damhuis RA, Wijnhoven BP, Plaisier PW, Kirkels WJ, Kranse R, van Lanschot JJ. Comparison of 30-day, 90-day and in-hospital postoperative mortality for eight different cancer types. Br J Surg 2012; 99: 1149-54. (PMID: 10.1002/bjs.8813)
Shaw AD, Bagshaw SM, Goldstein SL, et al. Major complications, mortality, and resource utilization after open abdominal surgery: 0.9% saline compared to Plasma-Lyte. Ann Surg 2012; 255: 821-9.
Myles PS, Bellomo R, Corcoran T, et al. Restrictive versus liberal fluid therapy for major abdominal surgery. N Engl J Med 2018; 378: 2263-74. (PMID: 10.1056/NEJMoa1801601)
Burnum JF, Hickam JB, McIntosh HD. The effect of hypocapnia on arterial blood pressure. Circulation 1954; 9: 89-95. (PMID: 10.1161/01.CIR.9.1.89)
Wong KC, Schafer PG, Schultz JR. Hypokalemia and anesthetic implications. Anesth Analg 1993; 77: 1238-60. (PMID: 10.1213/00000539-199312000-00027)
Curley G, Kavanagh BP, Laffey JG. Hypocapnia and the injured brain: more harm than benefit. Crit Care Med 2010; 38: 1348-59. (PMID: 10.1097/CCM.0b013e3181d8cf2b)
Takahashi CE, Brambrink AM, Aziz MF, et al. Association of intraprocedural blood pressure and end tidal carbon dioxide with outcome after acute stroke intervention. Neurocrit Care 2014; 20: 202-8. (PMID: 10.1007/s12028-013-9921-3)
Hovorka J. Carbon dioxide homeostasis and recovery after general anaesthesia. Acta Anaesthesiol Scand 1982; 26: 498-504. (PMID: 10.1111/j.1399-6576.1982.tb01806.x)
Wollman SB, Orkin LR. Postoperative human reaction time and hypocarbia during anaesthesia. Br J Anaesth 1968; 40: 920-6. (PMID: 10.1093/bja/40.12.920)
Abdalrazik FS, Elghonemi MO. Assessment of gradient between partial pressure of arterial carbon dioxide and end-tidal carbon dioxide in acute respiratory distress syndrome. Egypt J Bronchol 2019; 13: 170-5. (PMID: 10.4103/ejb.ejb_90_17)
Tyburski JG, Carlin AM, Harvey EH, Steffes C, Wilson RF. End-tidal CO2-arterial CO2 differences: a useful intraoperative mortality marker in trauma surgery. J Trauma 2003; 55: 892-6. (PMID: 10.1097/01.TA.0000097827.51916.7E)
Campion EM, Robinson CK, Brant N, et al. End-tidal carbon dioxide underestimates plasma carbon dioxide during emergent trauma laparotomy leading to hypoventilation and misguided resuscitation: a Western Trauma Association Multicenter Study. J Trauma Acute Care Surg 2019; 87: 1119-24. (PMID: 10.1097/TA.0000000000002469)
Shetty A, Sparenberg S, Adams K, et al. Arterial to end-tidal carbon dioxide tension difference (CO2 gap) as a prognostic marker for adverse outcomes in emergency department patients presenting with suspected sepsis. Emerg Med Australas 2018; 30: 794-801. (PMID: 10.1111/1742-6723.13095)
Isserles SA, Breen PH. Can changes in end-tidal PCO2 measure changes in cardiac output? Anesth Analg 1991; 73: 808-14. (PMID: 10.1213/00000539-199112000-00023)
Jin X, Weil MH, Tang W, et al. End-tidal carbon dioxide as a noninvasive indicator of cardiac index during circulatory shock. Crit Care Med 2000; 28: 2415-9. (PMID: 10.1097/00003246-200007000-00037)
Maslow A, Stearns G, Bert A, et al. Monitoring end-tidal carbon dioxide during weaning from cardiopulmonary bypass in patients without significant lung disease. Anesth Analg 2001; 92: 306-13. (PMID: 10.1213/00000539-200102000-00004)
Shibutani K, Muraoka M, Shirasaki S, Kubal K, Sanchala VT, Gupte P. Do changes in end-tidal PCO2 quantitatively reflect changes in cardiac output? Anesth Analg 1994; 79: 829-33. (PMID: 10.1213/00000539-199411000-00002)
Akça O, Kurz A, Fleischmann E, et al. Hypercapnia and surgical site infection: a randomized trial. Br J Anaesth 2013; 111: 759-67. (PMID: 10.1093/bja/aet233)
Coakley RJ, Taggart C, Greene C, McElvaney NG, O'Neill SJ. Ambient pCO2 modulates intracellular pH, intracellular oxidant generation, and interleukin-8 secretion in human neutrophils. J Leukoc Biol 2002; 71: 603-10. (PMID: 11927646)
Marhong J, Fan E. Carbon dioxide in the critically ill: too much or too little of a good thing? Respir Care 2014; 59: 1597-605. (PMID: 10.4187/respcare.03405)
Jaber S, Jung B, Sebbane M, et al. Alteration of the piglet diaphragm contractility in vivo and its recovery after acute hypercapnia. Anesthesiology 2008; 108: 651-8. (PMID: 10.1097/ALN.0b013e31816725a6)
Jaitovich A, Angulo M, Lecuona E, et al. High CO2 levels cause skeletal muscle atrophy via AMP-activated kinase (AMPK), FoxO3a protein, and muscle-specific Ring finger protein 1 (MuRF1). J Biol Chem 2015; 290: 9183-94. (PMID: 10.1074/jbc.M114.625715)
Grant Information:: 20K09242 the Japan Society for the Promotion of Science KAKENHI program
Contributed Indexing:: Keywords: End-tidal carbon dioxide; Intraoperative hypocapnia; Major abdominal surgery; Postoperative mortality
Local Abstract: [Publisher, French] RéSUMé: OBJECTIF: Il n’existe que très peu de données s’intéressant à l’effet du niveau peropératoire télé-expiratoire du dioxyde de carbone (EtCO 2 ) sur la mortalité postopératoire. L’objectif de cette étude était d’examiner la relation entre l’EtCO 2 peropératoire et la mortalité à 90 jours chez des patients subissant une chirurgie abdominale majeure sous anesthésie générale. MéTHODE: Nous avons réalisé une étude de cohorte historique portant sur des patients subissant une chirurgie abdominale majeure sous anesthésie générale à l’Hôpital universitaire de Kyoto. Nous avons mesuré l’EtCO 2 peropératoire, et les patients avec une valeur moyenne d’EtCO 2 < 35 mmHg ont été catégorisés comme EtCO 2 faible. L’effet temps a été déterminé en fonction de la durée, en minutes, avec une EtCO 2 inférieure à 35 mmHg, et les effets cumulatifs ont été évalués en mesurant l’aire sous le seuil de 35 mmHg pour chaque patient. RéSULTATS: Sur 4710 patients, 1374 (29 %) avaient une EtCO 2 faible et 55 (1,2 %) sont décédés dans les 90 jours suivant la chirurgie. Une analyse de régression multivariée de Cox, ajustée pour tenir compte des facteurs suivants : âge, statut physique selon l’American Society of Anesthesiologists, sexe, chirurgie par laparoscopie, chirurgie d’urgence, pertes de sang, tension artérielle moyenne, durée de la chirurgie, type de chirurgie et maladie pulmonaire obstructive chronique, a révélé une association entre une EtCO 2 faible et la mortalité à 90 jours (rapport de risque ajusté, 2,2; intervalle de confiance [IC] à 95 %, 1,2 à 3,8; P = 0,006). De plus, la sévérité de l’EtCO 2 basse était associée à une augmentation de la mortalité à 90 jours (aire sous le seuil; rapport de risque ajusté; 2,9, IC 95 %, 1,2 à 7,4; P =0,02); pour une exposition à long terme à une EtCO 2 < 35 mmHg (≥ 226 minutes), le rapport de risque ajusté pour une mortalité accrue à 90 jours était de 2,3 (IC 95 %, 0,9 à 6,0 ; P = 0,08). CONCLUSION: Une EtCO 2 peropératoire moyenne < 35 mmHg était associée à une augmentation de la mortalité postopératoire à 90 jours.
Substance Nomenclature:: 142M471B3J (Carbon Dioxide)
Entry Date(s):: Date Created: 20210806 Date Completed: 20211111 Latest Revision: 20220920
Update Code:: 20240105
DOI:: 10.1007/s12630-021-02086-z
PMID:: 34357567
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Purpose: There is a paucity of data on the effect of intraoperative end-tidal carbon dioxide (EtCO 2 ) levels on postoperative mortality. The purpose of this study was to investigate the relationship between intraoperative EtCO 2 and 90-day mortality in patients undergoing major abdominal surgery under general anesthesia.
Methods: We conducted a historical cohort study of patients undergoing major abdominal surgery under general anesthesia at Kyoto University Hospital. We measured the intraoperative EtCO 2 , and patients with a mean EtCO 2 value < 35 mm Hg were classified as low EtCO 2 . The time effect was determined based on minutes below an EtCO 2 of 35 mm Hg, and cumulative effects were evaluated by measuring the area under the threshold of 35 mm Hg for each patient.
Results: Of 4,710 patients, 1,374 (29%) had low EtCO 2 and 55 (1.2%) died within 90 days of surgery. Multivariable Cox regression analysis-adjusted for age, American Society of Anesthesiologists Physical Status classification, sex, laparoscopic surgery, emergency surgery, blood loss, mean arterial pressure, duration of surgery, type of surgery, and chronic obstructive pulmonary disease-revealed an association between low EtCO 2 and 90-day mortality (adjusted hazard ratio, 2.2; 95% confidence interval [CI], 1.2 to 3.8; P = 0.006). In addition, severity of low EtCO 2 was associated with an increased 90-day mortality (area under the threshold; adjusted hazard ratio; 2.9, 95% CI, 1.2 to 7.4; P =0.02); for long-term exposure to an EtCO 2 < 35 mm Hg (≥ 226 min), the adjusted hazard ratio for increased 90-day mortality was 2.3 (95% CI, 0.9 to 6.0; P = 0.08).
Conclusion: A mean intraoperative EtCO 2 < 35 mm Hg was associated with increased postoperative 90-day mortality.
(© 2021. Canadian Anesthesiologists' Society.)

Comment in: Can J Anaesth. 2021 Nov;68(11):1587-1591. (PMID: 34426960)
Comment in: Can J Anaesth. 2022 Mar;69(3):389-390. (PMID: 34817800)
Comment in: Can J Anaesth. 2022 Mar;69(3):391-392. (PMID: 34817801)

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