Low end-tidal CO2 as a real-time severity marker of intra-anaesthetic acute hypersensitivity reactions
| Autor: | L. de Chaisemartin, Pascale Nicaise-Roland, A. Sabahov, Aurélie Gouel-Chéron, Friederike Jönsson, Pierre Bruhns, Sylvie Chollet-Martin, M-T Guinnepain, C. Neukirch, Dan Longrois, Vanessa Granger |
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| Přispěvatelé: | Anticorps en thérapie et pathologie - Antibodies in Therapy and Pathology, Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie - réanimation chirurgicale [CHU Bichat], Université Paris Diderot - Paris 7 (UPD7)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Laboratoire d'Immunologie 'Autoimmunité et Hypersensibilités' [AP-HP Hôpital Bichat, Paris], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Inflammation, Chimiokines et Immunopathologie [Châtenay-Malabry], Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Hôpital Foch [Suresnes], Service de Pneumologie [Bichat], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 (UPD7)-Centre de Compétence pour les Maladies Pulmonaires Rares, Physiopathologie et Epidémiologie des Maladies Respiratoires (PHERE (UMR_S_1152 / U1152)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), The NASA study was financed by AP-HP through a « Contrat de Recherche Clinique 2011 », by INSERM (Institut National de la Santé et de la Recherche Médicale) and by DGOS (Direction Générale de l’Offre de Soins, Paris, France) through a « Recherche Clinique translationnelle 2012» grant. A.G.-C. benefited from a stipend provided by AP-HP, Paris, France and by the Institut Pasteur, Paris, France. F.J. is an employee of the Centre National de la Recherche Scientifique (CNRS). P.B. benefited from an additional support from AP-HP through a 'Contral Local d’Interface 2014' and the 'Département Hospitalo-Universitaire' (DHU) FIRE., NASA study group : Philippe Montravers MD PhD(1), Caitlin M. Gillis PhD(2), David A. Mancardi PhD(2), Michel Aubier MD PhD(3,4), Caroline Sauvan MD(4), Marc Fischler MD PhD(5), Julie Bresson MD(5), Catherine Paugam-Burtz MD PhD(6), Skander Necib MD(6), Alexandre Mebazaa MD PhD(7), Matthieu Le Dorze MD(7), Laurent Jacob MD PhD(8), Carole Chahine MD(8), Hawa Keita-Meyer MD PhD(9), Valentina Faitot MD(9), Olivier Langeron MD PhD(10), Sabrine Roche MD(10), Bernard Cholley MD PhD(11) and Jean Mantz MD Ph(D11),* - *Deceased (1) Département d'anesthésie-réanimation, Hôpital Bichat, AP-HP, Paris, France, (2) Unit of Antibodies in Therapy & Pathology, INSERM U1222, Institut Pasteur, Paris, France, (3) INSERM U1152, Universite Paris Diderot Paris 7, Paris, France, (4) Service de pneumologie et d'allergologie, Hôpital Bichat, AP-HP, DHU FIRE, Paris, France, (5) Département d'anesthésie-réanimation, Hôpital Foch, Suresnes, France, (6) Département d'anesthésie-réanimation, Hôpital Beaujon, AP-HP, Clichy, France, (7) Département d'anesthésie-réanimation, Hôpital Lariboisière, AP-HP, Paris, France, (8) Département d'anesthésie-réanimation, Hôpital Saint Louis, AP-HP, Paris, France, (9) Département d'anesthésie-réanimation, Hôpital Louis Mourier, AP-HP, Colombes, France, (10) Département d'anesthésie-réanimation, Hôpital Pitié Salpêtrière, AP-HP, Paris, France, and (11) Département d'anesthésie-réanimation, Hôpital Européen Georges Pompidou, AP-HP, Paris, France, Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Centre de Compétence pour les Maladies Pulmonaires Rares, Martin, Marie, Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP) |
| Rok vydání: | 2017 |
| Předmět: |
Male
Severity of Illness Index Hypoxemia MESH: Aged 80 and over 0302 clinical medicine Hypocapnia 030202 anesthesiology Anesthesia Young adult Intraoperative Complications neuromuscular blocking agents Aged 80 and over MESH: Aged MESH: Middle Aged MESH: Carbon Dioxide/metabolism anaesthesia Middle Aged MESH: Intraoperative Complications/diagnosis respiratory system 3. Good health MESH: Reproducibility of Results Epinephrine MESH: Young Adult Acute Disease MESH: Acute Disease [SDV.IMM]Life Sciences [q-bio]/Immunology Female medicine.symptom Anaphylaxis medicine.drug Adult medicine.medical_specialty Adolescent [SDV.IMM] Life Sciences [q-bio]/Immunology MESH: Intraoperative Complications/metabolism Drug Hypersensitivity Young Adult 03 medical and health sciences MESH: Severity of Illness Index Severity of illness anaphylaxis medicine Humans Aged MESH: Anesthesia/adverse effects MESH: Adolescent MESH: Humans MESH: Biomarkers/metabolism business.industry cardiac output Reproducibility of Results MESH: Adult Carbon Dioxide medicine.disease MESH: Male Confidence interval respiratory tract diseases Surgery Clinical trial hypocapnia Anesthesiology and Pain Medicine 030228 respiratory system general MESH: Drug Hypersensitivity/diagnosis MESH: Drug Hypersensitivity/metabolism business MESH: Female Biomarkers |
| Zdroj: | British Journal of Anaesthesia British Journal of Anaesthesia, Oxford University Press (OUP), 2017, 119 (5), pp.908-917. ⟨10.1093/bja/aex260⟩ British Journal of Anaesthesia, 2017, 119 (5), pp.908-917. ⟨10.1093/bja/aex260⟩ |
| ISSN: | 0007-0912 1471-6771 |
| DOI: | 10.1093/bja/aex260 |
| Popis: | Background Prompt diagnosis of intra-anaesthetic acute hypersensitivity reactions (AHR) is challenging because of the possible absence and/or difficulty in detecting the usual clinical signs and because of the higher prevalence of alternative diagnoses. Delayed epinephrine administration during AHR, because of incorrect/delayed diagnosis, can be associated with poor prognosis. Low end-tidal CO2 (etCO2) is known to be linked to low cardiac output. Yet, its clinical utility during suspected intra-anaesthetic AHR is not well documented. Methods Clinical data from the 86 patients of the Neutrophil Activation in Systemic Anaphylaxis (NASA) multicentre study were analysed. Consenting patients with clinical signs consistent with intra-anaesthetic AHR to a neuromuscular blocking agent were included. Severe AHR was defined as a Grade 3–4 of the Ring and Messmer classification. Causes of AHR were explored following recommended guidelines. Results Among the 86 patients, 50% had severe AHR and 69% had a confirmed/suspected IgE-mediated event. Occurrence and minimum values of arterial hypotension, hypocapnia and hypoxaemia increased significantly with the severity of AHR. Low etCO2 was the only factor able to distinguish mild [median 3.5 (3.2;3.9) kPa] from severe AHR [median 2.4 (1.6;3.0) kPa], without overlap in inter-quartile range values, with an area under the receiver operator characteristic curve of 0.92 [95% confidence interval: 0.79–1.00]. Among the 41% of patients who received epinephrine, only half received it as first-line therapy despite international guidelines. Conclusions An etCO2 value below 2.6 kPa (20 mm Hg) could be useful for prompt diagnosis of severe intra-anaesthetic AHR, and could facilitate early treatment with titrated doses of epinephrine. Clinical trial registration NCT01637220. |
| Databáze: | OpenAIRE |
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