Published in:
01-06-2017 | Correspondence
‘Permissive’ hypercapnia in ARDS: is it passé?
Published in: Intensive Care Medicine | Issue 6/2017
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Recently, Nin et al. demonstrated that hypercapnia was associated with a higher likelihood of intensive care unit (ICU) mortality in subjects with acute respiratory distress syndrome (ARDS) [1]. In order to investigate the effect of PaCO2 in our ICU population, we collected the demographic and clinical information of 415 subjects with ARDS admitted between 1 January 2001 and 31 December 2016. On a multivariate logistic regression analysis, baseline APACHE II, baseline pH and severity of ARDS were predictors of mortality, but the worst PaCO2 values during the initial 48 h were not (Table 1).
Table 1
Baseline parameters amongst ICU survivors and non-survivors with ARDS
|
Parameter
|
Survivors (n = 295)
|
Non-survivors (n = 120)
|
Crude OR (95% CI)
|
Adjusted OR (95% CI)
|
p value
|
|---|---|---|---|---|---|
|
Baseline APACHE II score
|
17 (11–24)
|
23 (17–28)
|
1.19 (1.06–1.11)**
|
1.062 (1–1.1)*
|
<0.0001
|
|
Baseline PaCO2, mmHg
|
37 (31.4–44)
|
41.2 (32.8–54)
|
1.03 (1.01–1.04)**
|
1 (0.97–1)
|
<0.0001
|
|
Worst PaCO2 in first 48 h, mmHg
|
39 (34–46)
|
43.5 (36–58)
|
1.03 (1.01–1.04)**
|
0.9 (0.9–1)
|
<0.0001
|
|
PaCO2 > 45 mmHg at 48 h
|
88 (29.8)
|
57 (47.5)
|
<0.001
|
||
|
Baseline pH
|
7.37 (7.31–7.41)
|
7.28 (7.19–7.37)
|
0.00 (0.00–0.01)**
|
0.01 (0.0–0.1)**
|
<0.0001
|
|
Severity of ARDS
|
0.59 (0.44–0.79)**
|
0.59 (0.35–0.99)*
|
0.001
|
||
|
Mild, n (%)
|
119 (40.3)
|
27 (22.5)
|
|||
|
Moderate, n (%)
|
124 (42)
|
59 (49.2)
|
|||
|
Severe, n (%)
|
52 (17.6)
|
34 (28.3)
|
|||
|
Baseline PaO2/FIO2 ratio
|
157.3 (57.5)
|
168.5 (72.7)
|
0.52
|
||
|
Baseline plateau pressure (cmH2O)
|
24.6 (5.6)
|
27.3 (6.8)
|
0.001
|
||
|
Baseline PEEP (cmH2O)
|
8.7 (4.4)
|
9.5 (4.4)
|
0.14
|
||
|
Respiratory rate/min
|
22.6 ± 14.5
|
24.3 ± 16.1
|
0.21
|
||
|
Duration of MV, days
|
7.5 (6.3)
|
7.5 (7.1)
|
0.96
|
||
|
Ventilator-free days
|
3.2 (4.0)
|
0.8 (2.5)
|
<0.0001
|
||
|
ICU length of stay, days
|
10.7 (8.9)
|
8.3 (8.3)
|
0.01
|
||
|
Hospital length of stay, days
|
17.2 (13.4)
|
13 (11)
|
0.002
|