Clinical practice and effect of carbon dioxide on outcomes in mechanically ventilated acute brain-injured patients: a secondary analysis of the ENIO study
Issued Date
2024-01-01
Resource Type
ISSN
03424642
eISSN
14321238
Scopus ID
2-s2.0-85183773177
Pubmed ID
38294526
Journal Title
Intensive Care Medicine
Rights Holder(s)
SCOPUS
Bibliographic Citation
Intensive Care Medicine (2024)
Suggested Citation
Robba C., Battaglini D., Abbas A., Sarrió E., Cinotti R., Asehnoune K., Taccone F.S., Rocco P.R., Schultz M.J., Citerio G., Stevens R.D., Badenes R. Clinical practice and effect of carbon dioxide on outcomes in mechanically ventilated acute brain-injured patients: a secondary analysis of the ENIO study. Intensive Care Medicine (2024). doi:10.1007/s00134-023-07305-3 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/97128
Title
Clinical practice and effect of carbon dioxide on outcomes in mechanically ventilated acute brain-injured patients: a secondary analysis of the ENIO study
Author's Affiliation
Instituto de Investigación Sanitaria Fundación Para la Investigación del Hospital Clínico de Valencia - INCLIVA
Mahidol Oxford Tropical Medicine Research Unit
IRCCS San Martino Polyclinic Hospital
Nantes Université
Hôtel Dieu CHU de Nantes
Università degli Studi di Genova
Hospital Clinico Universitario de Valencia
Università degli Studi di Milano-Bicocca
Nuffield Department of Medicine
Universitat de València
Amsterdam UMC - University of Amsterdam
Johns Hopkins School of Medicine
Universidade Federal do Rio de Janeiro
Fondazione IRCCS San Gerardo dei Tintori
Hôpital Universitaire de Bruxelles (HUB)
Mahidol Oxford Tropical Medicine Research Unit
IRCCS San Martino Polyclinic Hospital
Nantes Université
Hôtel Dieu CHU de Nantes
Università degli Studi di Genova
Hospital Clinico Universitario de Valencia
Università degli Studi di Milano-Bicocca
Nuffield Department of Medicine
Universitat de València
Amsterdam UMC - University of Amsterdam
Johns Hopkins School of Medicine
Universidade Federal do Rio de Janeiro
Fondazione IRCCS San Gerardo dei Tintori
Hôpital Universitaire de Bruxelles (HUB)
Corresponding Author(s)
Other Contributor(s)
Abstract
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.