An observational study of end-tidal carbon dioxide trends in general anesthesia.

Autor: Akkermans A; Department of Anesthesiology, University Medical Center Utrecht, Heidelberglaan 100, Local mail: Q04.2.313, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. a.akkermans@umcutrecht.nl., van Waes JAR; Department of Anesthesiology, University Medical Center Utrecht, Heidelberglaan 100, Local mail: Q04.2.313, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands., Thompson A; Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA., Shanks A; Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA., Peelen LM; Department of Anesthesiology, University Medical Center Utrecht, Heidelberglaan 100, Local mail: Q04.2.313, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands., Aziz MF; Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA., Biggs DA; Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA., Paganelli WC; Department of Anesthesiology, University of Vermont Larner College of Medicine, Burlington, VT, USA., Wanderer JP; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA., Helsten DL; Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA., Kheterpal S; Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA., van Klei WA; Department of Anesthesiology, University Medical Center Utrecht, Heidelberglaan 100, Local mail: Q04.2.313, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands., Saager L; Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA.
Jazyk: angličtina
Zdroj: Canadian journal of anaesthesia = Journal canadien d'anesthesie [Can J Anaesth] 2019 Feb; Vol. 66 (2), pp. 149-160. Date of Electronic Publication: 2018 Nov 14.
DOI: 10.1007/s12630-018-1249-1
Abstrakt: Purpose: Despite growing evidence supporting the potential benefits of higher end-tidal carbon dioxide (ETCO 2 ) levels in surgical patients, there is still insufficient data to formulate guidelines for ideal intraoperative ETCO 2 targets. As it is unclear which intraoperative ETCO 2 levels are currently used and whether these levels have changed over time, we investigated the practice pattern using the Multicenter Perioperative Outcomes Group database.
Methods: This retrospective, observational, multicentre study included 317,445 adult patients who received general anesthesia for non-cardiothoracic procedures between January 2008 and September 2016. The primary outcome was a time-weighted average area-under-the-curve (TWA-AUC) for four ETCO 2 thresholds (< 28, < 35, < 45, and > 45 mmHg). Additionally, a median ETCO 2 was studied. A Kruskal-Wallis test was used to analyse differences between years. Random-effect multivariable logistic regression models were constructed to study variability.
Results: Both TWA-AUC and median ETCO 2 showed a minimal increase in ETCO 2 over time, with a median [interquartile range] ETCO 2 of 33 [31.0-35.0] mmHg in 2008 and 35 [33.0-38.0] mmHg in 2016 (P <0.001). A large inter-hospital and inter-provider variability in ETCO 2 were observed after adjustment for patient characteristics, ventilation parameters, and intraoperative blood pressure (intraclass correlation coefficient 0.36; 95% confidence interval, 0.18 to 0.58).
Conclusions: Between 2008 and 2016, intraoperative ETCO 2 values did not change in a clinically important manner. Interestingly, we found a large inter-hospital and inter-provider variability in ETCO 2 throughout the study period, possibly indicating a broad range of tolerance for ETCO 2 , or a lack of evidence to support a specific targeted range. Clinical outcomes were not assessed in this study and they should be the focus of future research.
Databáze: MEDLINE
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