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Browsing by Author "Lorente, JA"

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  • Severe Hypercapnia and Outcome of Mechanically Ventilated Patients with Moderate or Severe Acute Respiratory Distress Syndrome
    Publication . Nin, N; Muriel, A; Peñuelas, O; Brochard, L; Lorente, JA; Ferguson, N; Raymondos, K; Ríos, F; Violi, DA; Thille, A; González, M; Villagomez, AJ; Hurtado, J; Davies, AR; Du, B; Maggiore, SM; Soto, L; D'Empaire, G; Matamis, D; Abroug, F; Moreno, R; Soares, MA; Arabi, Y; Sandi, F; Jibaja, M; Amin, P; Koh, Y; Kuiper, MA; Bülow, HH; Zeggwagh, AA; Anzueto, A; Sznajder, J; Esteban, A
    PURPOSE: To analyze the relationship between hypercapnia developing within the first 48 h after the start of mechanical ventilation and outcome in patients with acute respiratory distress syndrome (ARDS). PATIENTS AND METHODS: We performed a secondary analysis of three prospective non-interventional cohort studies focusing on ARDS patients from 927 intensive care units (ICUs) in 40 countries. These patients received mechanical ventilation for more than 12 h during 1-month periods in 1998, 2004, and 2010. We used multivariable logistic regression and a propensity score analysis to examine the association between hypercapnia and ICU mortality. MAIN OUTCOMES: We included 1899 patients with ARDS in this study. The relationship between maximum PaCO2 in the first 48 h and mortality suggests higher mortality at or above PaCO2 of ≥50 mmHg. Patients with severe hypercapnia (PaCO2 ≥50 mmHg) had higher complication rates, more organ failures, and worse outcomes. After adjusting for age, SAPS II score, respiratory rate, positive end-expiratory pressure, PaO2/FiO2 ratio, driving pressure, pressure/volume limitation strategy (PLS), corrected minute ventilation, and presence of acidosis, severe hypercapnia was associated with increased risk of ICU mortality [odds ratio (OR) 1.93, 95% confidence interval (CI) 1.32 to 2.81; p = 0.001]. In patients with severe hypercapnia matched for all other variables, ventilation with PLS was associated with higher ICU mortality (OR 1.58, CI 95% 1.04-2.41; p = 0.032). CONCLUSIONS: Severe hypercapnia appears to be independently associated with higher ICU mortality in patients with ARDS.
    2017-02Journal article Open access Show more