TY - JOUR
T1 - Étude observationnelle sur les tendances des valeurs du dioxyde de carbone en fin d’expiration au cours de l’anesthésie générale
AU - Akkermans, Annemarie
AU - van Waes, Judith A.R.
AU - Thompson, Aleda
AU - Shanks, Amy
AU - Peelen, Linda M.
AU - Aziz, Michael F.
AU - Biggs, Daniel A.
AU - Paganelli, William C.
AU - Wanderer, Jonathan P.
AU - Helsten, Daniel L.
AU - Kheterpal, Sachin
AU - van Klei, Wilton A.
AU - Saager, Leif
N1 - Funding Information:
The authors gratefully acknowledge the valuable contributions to protocol development and final manuscript review by the MPOG Perioperative Clinical Research Committee. None declared. This submission was handled by Dr. Philip M. Jones, Associate Editor, Canadian Journal of Anesthesia. Annemarie Akkermans contributed to the study design, study coordination, and writing of the manuscript. Aleda Thompson and Amy Shanks contributed to the study design, study coordination, data analysis, and writing of the manuscript. Judith A. R. van Waes , Linda M. Peelen , Michael F. Aziz , Daniel A. Biggs , William C. Paganelli , Jonathan P. Wanderer , Daniel L. Helsten , Sachin Kheterpal , Wilton A. van Klei , and Leif Saager contributed to the study design and writing of the manuscript. None.
Publisher Copyright:
© 2018, The Author(s).
PY - 2019/2
Y1 - 2019/2
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85056699639&partnerID=8YFLogxK
U2 - 10.1007/s12630-018-1249-1
DO - 10.1007/s12630-018-1249-1
M3 - Article
C2 - 30430440
AN - SCOPUS:85056699639
SN - 0832-610X
VL - 66
SP - 149
EP - 160
JO - Canadian Journal of Anesthesia
JF - Canadian Journal of Anesthesia
IS - 2
ER -