Title: | Association of intraoperative end-tidal CO2 levels with postoperative outcomes: a patient-level analysis of two randomised clinical trials |
Authors: | Nasa, Prashant van Meenen, David M.P. Paulus, Frederique Ferrando, Carlos Bluth, Thomas Gama de Abreu, Marcelo Ball, Lorenzo Bossers, Sebastiaan M. Schober, Patrick Schultz, Marcus J. Serpa Neto, Ary Hemmes, Sabrine N.T. Campos, Niklas S. Bluth, Thomas Hemmes, Sabrine N.T. Librero, Julian Pozo, Natividad Ferrando, Carlos Ball, Lorenzo Mazzinari, Guido Pelosi, Paolo Gama de Abreu, Marcelo Schultz, Marcus J. Neto, Ary Serpa Hemmes, Sabrine N.T. Gama de Abreu, Marcelo Severgnini, Paolo Hollmann, Markus W. Binnekade, Jan M. Wrigge, Hermann Canet, Jaume Hiesmayr, Michael Schmid, Werner Tschernko, Edda Jaber, Samir Hedenstierna, Göran Putensen, Christian Pelosi, Paolo Schultz, Marcus J. Marti, Agnes Bacuzzi, Alessandro Brodhun, Alexander Molin, Alexandre Merten, Alfred Parera, Ana Brunelli, Andrea Cortegiani, Andrea Güldner, Andreas Reske, Andreas W. Gratarola, Angelo Giarratano, Antonino Bastin, Bea Heyse, Bjorn Mazul-Sunko, Branka Amantea, Bruno Barberis, Bruno Putensen, Christian Uhlig, Christopher Marín, Conrado Minguez Celentano, Cristian La Bella, Daniela D’Antini, David Velghe, David Sulemanji, Demet De Robertis, Edoardo Hartmann, Eric Montalto, Francesca Tropea, Francesco Mills, Gary H. Cinnella, Gilda Della Rocca, Giorgio Caggianelli, Girolamo Pellerano, Giulia Mollica, Giuseppina Bugedo, Guillermo Wrigge, Hermann Mulier, Jan-Paul Vandenbrande, Jeroen Geib, Johann Yaqub, Jonathan Florez, Jorge Mayoral, Juan F. Sprung, Juraj Van Limmen, Jurgen Bos, Lieuwe D.J. de Baerdemaeker, Luc Jamaer, Luc Spagnolo, Luigi Strys, Lydia Gil, Manuel Granell Gama de Abreu, Marcelo Vidal Melo, Marcos F. Schultz, Marcus J. Unzueta, Maria Carmen Moral, Maria Victoria Ferner, Marion Hollmann, Markus W. Weiss, Martin Vanoni, Massimo Schaefer, Maximilian S. Prieto, Mercè Grio, Michele Severgnini, Paolo Spieth, Peter Markus Simon, Philipp Bodger, Phoebe Sierra, Pilar Laufenberg-Feldmann, Rita Rusca, Roberta Proietti, Rodolfo Hemmes, Sabrine N.T. Raineri, Santi Maurizio Caroleo, Santo Sabaté, Sergi De Hert, Stefan Pezzato, Stefano Treschan, Tanja A. Goranovic, Tatjana Koch, Thea Bluth, Thomas Kiss, Thomas Perilli, Valter Cegarra, Virginia Schmid, Werner Bluth, Thomas Neto, Ary Serpa Bobek, Ilona Canet, Jaume Cinnella, Gilda de Baerdemaeker, Luc Gregoretti, Cesare Hedenstierna, Göran Hemmes, Sabrine N.T. Hiesmayr, Michael Hollmann, Markus W. Jaber, Samir Laffey, John Licker, Marc-Joseph Markstaller, Klaus Matot, Idit Mills, Gary H. Mulier, Jan Paul Putensen, Christian Rossaint, Rolf Schmitt, Jochen Senturk, Mert Severgnini, Paolo Sprung, Juraj Vidal Melo, Marcos F. Wrigge, Hermann Schultz, Marcus J. Pelosi, Paolo Gama de Abreu, Marcelo Abelha, Fernando Abitağaoğlu, Sühayla Achilles, Marc Adebesin, Afeez Adriaensens, Ine Fatima Akbar, Charles Ahene. Al Harbi, Mohammed Al Khoury al Kallab, Rita Albanel, Xavier Aldenkortt, Florence Saleh Alfouzan, Rawan Abdullah Alruqaie, Reef Altermatt, Fernando Luís de Castro Araujo, Bruno Genaro, Arbesú Artsi, Hanna Omer Hilmi Ayanoglu, Caterina Aurilio. Bacuzzi, Alessandro Baig, Harris Baird, Yolanda Jaume Balust, Konstantin Balonov. Banks, Samantha Bao, Xiaodong Baumgartner, Mélanie Tortosa, Isabel Belda Bergamaschi, Alice Bergmann, Lars Bigatello, Luca Pérez, Elena Biosca Birr, Katja Bluth, Thomas Bojaxhi, Elird Bonenti, Chiara Bonney, Iwona Bos, Elke M.E. Bowman, Sara Braz, Leandro Gobbo Brugnoni, Elisa Brull, Sorin J. Brunetti, Iole Bruni, Andrea Buenvenida, Shonie L. Busch, Cornelius Johannes Camerini, Giovanni Canet, Jaume Capatti, Beatrice Carmona, Javiera Carungcong, Jaime Ribeiro Carvalho,Marta Cattan, Anat Cavaleiro, Carla Chiumello, Davide Ciardo, Stefano Coburn, Mark Colella, Umberto Contreras, Victor Dincer, Pelin Corman Cotter, Elizabeth Crovetto, Marcia Darrah, William Davies, Simon de Baerdemaeker, Luc De Hert, Stefan Del Cojo Peces, Enrique Delphin, Ellise Diaper, John Junior, Paulo do Nascimento Donatiello, Valerio Dong, Jing Dourado, Maria do Socorro Dullenkopf, Alexander Ebner, Felix Elgendy, Hamed Ellenberger, Christoph Arı, Dilek Erdoğan Ermert, Thomas Farah, Fadi Fernandez-Bustamante, Ana Ferreira, Cristina Fiore, Marco Fonte, Ana Palahí, Christina Fortià Galimberti, Andrea Gama de Abreu, Marcelo Garofano, Najia Giaccari, Luca Gregorio Gilsanz, Fernando Girrbach, Felix Gobbi, Luca Godfried, Marc Bernard Goettel, Nicolai Goldstein, Peter A. Goren, Or Gorlin, Andrew Manuel, Granell Gil Gratarola, Angelo Graterol, Juan Guyon, Pierre Haire, Kevin Harou, Philippe Helf, Antonia Hemmes, Sabrine N.T. Hempel, Gunther Hernández Cádiz, María José Heyse, Björn Hollmann, Markus W. Huercio, Ivan Ilievska, Jasmina Jakus, Lien Jeganath, Vijay Jelting, Yvonne Jung, Minoa Kabon, Barbara Kacha, Aalok Ilić, Maja Karaman Karuppiah, Arunthevaraja Kavas, Ayse Duygu Barcelos, Gleicy Keli Kellogg, Todd A. Kemper, Johann Kerbrat, Romain Khodr, Suraya Kienbaum, Peter Kir, Bunyamin Kiss, Thomas Kivrak, Selin Klarić, Vlasta Koch, Thea Köksal, Ceren Kowark, Ana Kranke, Peter Kuvaki, Bahar Kuzmanovska, Biljana Laffey, John Lange, Mirko Freitas de Lemos, Marília Licker, Marc-Joseph López-Baamonde, Manuel López-Hernández, Antonio Lopez-Martinez, Mercedes Luise, Stéphane MacGregor, Mark Magalhães, Danielle Maillard, Julien Malerbi, Patrizia Manimekalai, Natesan Margarson, Michael Markstaller, Klaus Martin, Archer K. Martin, David P. Martin, Yvette N. Martínez-Ocon, Julia Martin-Loeches, Ignacio Maseda, Emilio Matot, Idit McAuliffe, Niamh McKenzie, Travis J. Medina, Paulina Meersch, Melanie Els Mertens. Bernd Meurer, Angelika Menzen. Meyer-Treschan. Changhong Miao. Camilla Micalizzi, Tanja Milić, Morena Pinheiro Módolo, Norma Sueli Moine, Pierre Mölders, Patrick Montero-Feijoo, Ana Moret, Enrique Muller, Markus K. Murphy, Zoe Nalwaya, Pramod Navalesi Paolo, Filip Naumovski. Navarro e Lima, Lais Helena Adam, Višnja Nesek Neumann, Claudia Newell, Christopher Nisnevitch, Zoulfira Nizamuddin, Junaid Novazzi, Cecilia O'Connor, Michael Oprea, Günther Sungur, Mukadder Orhan Özbilgin, Şule Pace, Maria Caterina Pacheco, Marcos Packianathaswamy, Balaji Gonzalez, Estefania Palma Sebastián Paredes, Fotios Papaspyros. Passavanti, Maria Beatrice Pedemonte, Juan Cristobal Sanja Peremin, Paolo Pelosi. Philipsenburg, Christoph Pinho, Daniela Pinho, Silvia Posthuma, Linda M. Pota, Vincenzo Preckel, Benedikt Priani, Paolo Putensen, Christian Rached, Mohamed Aymen Radoeshki, Aleksandar Ragazzi, Riccardo Rajamanickam, Tamilselvan Rajamohan, Arthi Desikan Rangarajan. Christian Reiterer, Harish Ramakrishna. Renew, J.Ross Reynaud, Thomas Rhys, Rhidian Luisa Robitzky, Eva Rivas. Francesca Rubulotta. S. Machado Humberto, Rolf Rossaint. Catarina, S.Nunes Sabbatini, Giovanni Samuels, Jon D. Sanahuja, Josep Martí Sansone, Pasquale Santos, Alice Sayedalahl, Mohamed Schaefer, Maximilian S. Scharffenberg, Martin Schiffer, Eduardom Schliewe, Nadja Schorer, Raoul Schultz, Marcus J. Schumann, Roman Selmo, Gabriele Sendra, Mar Senturk, Mert Kate Shaw, Paolo Severgnini. Abdulrazak Sibai. Philipp Simon, Mirjana Shosholcheva. Simonassi, Francesca Sinno, Claudia Sivrikoz, Nukhet Neil Smith, Vasiliki Skandalou. Soares, Maria Artiles, Tania Socorro Castro. Miguel Sousa, Diogo Sousa Juraj Sprung, Savino Spadaro. Stamatakis, Emmanouil Steiner, Luzius A. Stevenazzi, Andrea Suarez-de-la-Rica. Mélanie Suppan, Alejandro Teichmann, Robert Tena Guerrero. Bram Thiel, José Maria Tolós, Raquel Altun, Gulbin Tore Tucci, Michelle Turnbull, Zachary A. Turudić, Žana Unterberg, Matthias Van Limmen, Jurgen Van Nieuwenhove, Yves Van Waesberghe, Julia Vidal Melo. Bibiana Vitković, Marcos Francisco Vivona, Luigi Carlo Alberto Volta, Marcela Vizcaychipi. Weber, Anne Weingarten, Toby N. Wittenstein, Jakob Wrigge, Hermann Wyffels, Piet Yagüe, Julio Yates, David Yavru, Ayşen Zac, Lilach Zhong, Jing Ferrando, Carlos Belda, Javier Soro, Marina Canet, Jaume Unzueta, Carmen Suarez-Sipmann, Fernando Librero, Julián Llombart, Alicia Rovira, Lucas Granell, Manuel Aldecoa, César Diaz-Cambronero, Oscar Balust, Jaume Garutti, Ignacio Martín González, Rafael Gabriel Gallego, Lucia Garcia del Valle, Santiago Redondo, Javier Pestaña, David Rodríguez Pérez, Aurelio Eduardo García García, Javier Agustín Matta, Manuel de la Ibáñez, Maite Barrios, Francisco Hernández, Samuel Torres, Vicente Peiró, Salvador Pozo, Natividad Villena, Abigail Carramiñana, Albert Gallego-Casilda, Alberto Duca, Alejandro Alcón, Amalia Miñana, Amanda Asensio, Ana Colás, Ana Galve, Ana Isabel Izquierdo, Ana Jurado, Ana Pérez, Ana María Mugarra, Ana Parera, Ana Brunelli, Andrea Gutierrez, Andrea Ramos De Miguel, Ángel Lozano, Angels Katime, Antonio Romero, Antonio Garrigues, Beatriz Ayas, Begoña Arocas, Blanca Delgado, Carlos Fernández, Carmen Romero, Carolina Gallego, Clara Garcés, Cristina Lisbona, Cristina Parrilla, Cristina López-Herrera, Daniel González, Domingo Llamazares, Eduardo Del Rio, Elena Lozano, Elena Pastor, Ernesto Chamorro, Estefanía Gracia, Estefanía Sánchez, Ester Romero, Esther Díez, Fernando Serralta, Ferran Daviu, Francisco Sandín, Francisco Aguilar, Gerardo Tusman, Gerardo Azparren, Gonzalo Martínez-Pallí, Graciela Mazzinari, Guido Benítez, Inmaculada Hernández González, Inmaculada Servanda India, Inmaculada León, Irene Fuentes, Isabel Ruiz, Isabel Puig, Jaume Román, Javie Ignacio Acosta, Jesús Rico-Feijoo, Jesús Olmedo, Jonathan Carbonell, Jose A. Alonso, Jose M. Pérez, Jose María Marcos, Jose Miguel Navarro, Jose Valdivia, Jose Carrizo, Juan Piqueras, Laura Soriano, Laura Vaquero, Laura Miguel, Lisset Muñoz, Lorena Valencia, Lucia Olmedilla, Luis Etulain, Ma Justina Tisner, Manuel Barrio, María Alonso, María Dolores García, María Hernández, María J. Alberola, María José González Parra, María Del Mar Argente, María Pilar Vila, María De Fez, Mario Agilaga, Marta Gine, Marta Ayuso, Mercedes García, Mercedes Bejarano, Natalia Peña, Natalia Ojeda, Nazario Martínez, Nilda García, Nuria Padrón, Oto Almodóvar García, Pablo Valls, Paola Cruz, Patricia Piñeiro, Patricia Charco, Pedro Anaya, Rafael López, Ramiro Rodríguez, Rayco Martínez, Rocío Pujol, Roger Dosdá, Rosa Lardies, Rosa Díaz, Ruben Villazala, Rubén Zapatero, Sara Cabrera, Sergio Sánchez, Sergio Martin, Silvia Diaz, Suzana Franco, Tania Moreno, Tania Socorro, Tania Gilabert, Vicente Balandrón, Victor Moral, Victoria Cegarra, Virgina Varón, Viviana |
UNESCO Clasification: | 32 Ciencias médicas 321303 Anestesiología |
Keywords: | Anaesthesia Carbon dioxide End-tidal CO2 EtCO2 Intraoperative ventilation, et al |
Issue Date: | 2025 |
Journal: | British journal of anaesthesia |
Abstract: | Background
The relationship between intraoperative end-tidal CO2 (etCO2) levels and postoperative outcomes remains unclear. We conducted a post hoc analysis of two randomised trials in adults undergoing major surgery under general anaesthesia.
Methods
We re-analysed individual participant data comparing high or low positive end-expiratory pressure with low tidal volume intraoperative ventilation using a merged database derived from two randomised trials in non-obese (PROVHILO: ISRCTN70332574) and obese (PROBESE: NCT02148692) patients. The exposure of interest was low etCO2 (<4.7 kPa) vs normal-high etCO2 (≥4.7 kPa). The primary outcome was postoperative pulmonary complications within 5 days. A time-weighted etCO2 analysis and propensity score matching were also performed to adjust for confounding.
Results
Of 2793 participants, 891 (29.4%; 52% female) had low etCO2, compared with 1972/2793 (70.6%; 65% female) participants with normal-high etCO2. Compared with participants with normal-high etCO2, higher minute volumes (normalised to body weight) were delivered in participants with low etCO2. Postoperative pulmonary complications developed in 278/821 (34%) participants with low etCO2, compared with 462/1972 (23%) participants who had normal-high etCO2 (adjusted hazard ratio, 1.3; 95% confidence interval, 1.1–1.6; P<0.001). The time-weighted analysis showed an inverse linear relationship between the mean etCO2 and postoperative pulmonary complications, which was also confirmed by propensity matching.
Conclusions
Low etCO2 occurs often during intraoperative ventilation and is associated with a higher rate of PPCs. The etCO2 level has an inverse dose-dependent relationship with postoperative pulmonary complications.
Clinical trial registration
NCT05550181. |
URI: | https://accedacris.ulpgc.es/jspui/handle/10553/147325 |
ISSN: | 0007-0912 |
DOI: | 10.1016/j.bja.2025.07.076 |
Source: | British journal of anaesthesia [eISSN 0007-0912], (Septiembre 2025) |
Appears in Collections: | Artículos
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