Associations of intraoperative end–tidal CO<inf>2</inf> levels with postoperative outcome–secondary analysis of a worldwide observational study
Issued Date
2025-02-01
Resource Type
ISSN
09528180
eISSN
18734529
Scopus ID
2-s2.0-85212532958
Journal Title
Journal of Clinical Anesthesia
Volume
101
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Clinical Anesthesia Vol.101 (2025)
Suggested Citation
Nasa P., van Meenen D.M.P., Paulus F., de Abreu M.G., Bossers S.M., Schober P., Schultz M.J., Neto A.S., Hemmes S.N.T., Kroell W., Metzler H., Struber G., Wegscheider T., Gombotz H., Hiesmayr M., Schmid W., Urbanek B., Kahn D., Momeni M., Pospiech A., Lois F., Forget P., Grosu I., Poelaert J., van Mossevelde V., van Malderen M.C., Dylst D., van Melkebeek J., Beran M., de Hert S., De Baerdemaeker L., Heyse B., Van Limmen J., Wyffels P., Jacobs T., Roels N., De Bruyne A., van de Velde S., Leva B., Damster S., Plichon B., JurosZovko M., Djonovic-Omanoviċ D., Pernar S., Zunic J., Miskovic P., Zilic A., Kvolik S., Ivic D., Azenic-Venzera D., Skiljic S., Vinkovic H., Oputric I., Juricic K., Frkovic V., Kopic J., Mirkovic I., Karanovic N., Carev M., Dropulic N., Saric J.P., Erceg G., Dvorscak M.B., Mazul-Sunko B., Pavicic A.M., Goranovic T., Maldini B., Radocaj T., Gavranovic Z., Mladic-Batinica I., Sehovic M., Stourac P., Harazim H., Smekalova O., Kosinova M., Kolacek T., Hudacek K., Drab M., Brujevic J., Vitkova K., Jirmanova K., Volfova I., Dzurnakova P., Liskova K., Dudas R., Filipsky R., El Kafrawy S., Abdelwahab H.H., Metwally T., Abdel-Razek A., El-Shaarawy A.M., Hasan W.F., Ahmed A.G., Yassin H., Magdy M., Abdelhady M., Mahran M., Herodes E., Kivik P., Oganjan J. Associations of intraoperative end–tidal CO<inf>2</inf> levels with postoperative outcome–secondary analysis of a worldwide observational study. Journal of Clinical Anesthesia Vol.101 (2025). doi:10.1016/j.jclinane.2024.111728 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/103000
Title
Associations of intraoperative end–tidal CO<inf>2</inf> levels with postoperative outcome–secondary analysis of a worldwide observational study
Author(s)
Nasa P.
van Meenen D.M.P.
Paulus F.
de Abreu M.G.
Bossers S.M.
Schober P.
Schultz M.J.
Neto A.S.
Hemmes S.N.T.
Kroell W.
Metzler H.
Struber G.
Wegscheider T.
Gombotz H.
Hiesmayr M.
Schmid W.
Urbanek B.
Kahn D.
Momeni M.
Pospiech A.
Lois F.
Forget P.
Grosu I.
Poelaert J.
van Mossevelde V.
van Malderen M.C.
Dylst D.
van Melkebeek J.
Beran M.
de Hert S.
De Baerdemaeker L.
Heyse B.
Van Limmen J.
Wyffels P.
Jacobs T.
Roels N.
De Bruyne A.
van de Velde S.
Leva B.
Damster S.
Plichon B.
JurosZovko M.
Djonovic-Omanoviċ D.
Pernar S.
Zunic J.
Miskovic P.
Zilic A.
Kvolik S.
Ivic D.
Azenic-Venzera D.
Skiljic S.
Vinkovic H.
Oputric I.
Juricic K.
Frkovic V.
Kopic J.
Mirkovic I.
Karanovic N.
Carev M.
Dropulic N.
Saric J.P.
Erceg G.
Dvorscak M.B.
Mazul-Sunko B.
Pavicic A.M.
Goranovic T.
Maldini B.
Radocaj T.
Gavranovic Z.
Mladic-Batinica I.
Sehovic M.
Stourac P.
Harazim H.
Smekalova O.
Kosinova M.
Kolacek T.
Hudacek K.
Drab M.
Brujevic J.
Vitkova K.
Jirmanova K.
Volfova I.
Dzurnakova P.
Liskova K.
Dudas R.
Filipsky R.
El Kafrawy S.
Abdelwahab H.H.
Metwally T.
Abdel-Razek A.
El-Shaarawy A.M.
Hasan W.F.
Ahmed A.G.
Yassin H.
Magdy M.
Abdelhady M.
Mahran M.
Herodes E.
Kivik P.
Oganjan J.
van Meenen D.M.P.
Paulus F.
de Abreu M.G.
Bossers S.M.
Schober P.
Schultz M.J.
Neto A.S.
Hemmes S.N.T.
Kroell W.
Metzler H.
Struber G.
Wegscheider T.
Gombotz H.
Hiesmayr M.
Schmid W.
Urbanek B.
Kahn D.
Momeni M.
Pospiech A.
Lois F.
Forget P.
Grosu I.
Poelaert J.
van Mossevelde V.
van Malderen M.C.
Dylst D.
van Melkebeek J.
Beran M.
de Hert S.
De Baerdemaeker L.
Heyse B.
Van Limmen J.
Wyffels P.
Jacobs T.
Roels N.
De Bruyne A.
van de Velde S.
Leva B.
Damster S.
Plichon B.
JurosZovko M.
Djonovic-Omanoviċ D.
Pernar S.
Zunic J.
Miskovic P.
Zilic A.
Kvolik S.
Ivic D.
Azenic-Venzera D.
Skiljic S.
Vinkovic H.
Oputric I.
Juricic K.
Frkovic V.
Kopic J.
Mirkovic I.
Karanovic N.
Carev M.
Dropulic N.
Saric J.P.
Erceg G.
Dvorscak M.B.
Mazul-Sunko B.
Pavicic A.M.
Goranovic T.
Maldini B.
Radocaj T.
Gavranovic Z.
Mladic-Batinica I.
Sehovic M.
Stourac P.
Harazim H.
Smekalova O.
Kosinova M.
Kolacek T.
Hudacek K.
Drab M.
Brujevic J.
Vitkova K.
Jirmanova K.
Volfova I.
Dzurnakova P.
Liskova K.
Dudas R.
Filipsky R.
El Kafrawy S.
Abdelwahab H.H.
Metwally T.
Abdel-Razek A.
El-Shaarawy A.M.
Hasan W.F.
Ahmed A.G.
Yassin H.
Magdy M.
Abdelhady M.
Mahran M.
Herodes E.
Kivik P.
Oganjan J.
Author's Affiliation
Universitätsklinikum Carl Gustav Carus Dresden
Mahidol Oxford Tropical Medicine Research Unit
Melbourne Medical School
Antoni van Leeuwenhoek Ziekenhuis
Cleveland Clinic Foundation
New Cross Hospital
Monash University
Hospital Israelita Albert Einstein
Medizinische Universität Wien
Nuffield Department of Medicine
Austin Hospital
Amsterdam UMC - University of Amsterdam
Helicopter Emergency Medical Service Lifeliner 1
Mahidol Oxford Tropical Medicine Research Unit
Melbourne Medical School
Antoni van Leeuwenhoek Ziekenhuis
Cleveland Clinic Foundation
New Cross Hospital
Monash University
Hospital Israelita Albert Einstein
Medizinische Universität Wien
Nuffield Department of Medicine
Austin Hospital
Amsterdam UMC - University of Amsterdam
Helicopter Emergency Medical Service Lifeliner 1
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: Patients receiving intraoperative ventilation during general anesthesia often have low end–tidal CO2 (etCO2). We examined the association of intraoperative etCO2 levels with the occurrence of postoperative pulmonary complications (PPCs) in a conveniently–sized international, prospective study named ‘Local ASsessment of Ventilatory management during General Anesthesia for Surgery’ (LAS VEGAS). Methods: Patients at high risk of PPCs were categorized as ‘low etCO2’ or ‘normal to high etCO2’ patients, using a cut–off of 35 mmHg. The primary endpoint was a composite of previously defined PPCs; the individual PPCs served as secondary endpoints. The need for unplanned oxygen was defined as mild PPCs and severe PPCs included pneumonia, respiratory failure, acute respiratory distress syndrome, barotrauma, and new invasive ventilation. We performed propensity score matching and LOESS regression to evaluate the relationship between the lowest etCO2 and PPCs. Results: The analysis included 1843 (74 %) ‘low etCO2’ patients and 648 (26 %) ‘normal to high etCO2’ patients. There was no difference in the occurrence of PPCs between ‘low etCO2’ and ‘normal to high etCO2’ patients (20 % vs. 19 %; RR 1.00 [95 %–confidence interval 0.94 to 1.06]; P = 0.84). The proportion of severe PPCs among total occurring PPCs, were higher in ‘low etCO2’ patients compared to ‘normal to high etCO2’ patients (35 % vs. 18 %; RR 1.16 [1.08 to 1.25]; P < 0.001). Propensity score matching did not change these findings. LOESS plot showed an inverse relationship of intraoperative etCO2 levels with the occurrence of PPCs. Conclusions: In this cohort of patients at high risk of PPCs, the overall occurrence of PPCs was not different between ‘low etCO2’ patients and ‘normal to high etCO2’ patients, but severe PPCs occurred more often in ‘low etCO2’, with an inverse dose–dependent relationship between intraoperative etCO2 levels and PPCs. Funding: This analysis was performed without additional funding. LAS VEGAS was partially funded and endorsed by the European Society of Anesthesiology and Intensive Care (ESAIC) and the Amsterdam University Medical Centers, location ‘AMC’. Registration: LAS VEGAS was registered at Clinicaltrials.gov (NCT01601223), first posted on May 17, 2012.