+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Severe hypercapnia and outcome of mechanically ventilated patients with moderate or severe acute respiratory distress syndrome



Severe hypercapnia and outcome of mechanically ventilated patients with moderate or severe acute respiratory distress syndrome



Intensive Care Medicine 43(2): 200-208



To analyze the relationship between hypercapnia developing within the first 48 h after the start of mechanical ventilation and outcome in patients with acute respiratory distress syndrome (ARDS). We performed a secondary analysis of three prospective non-interventional cohort studies focusing on ARDS patients from 927 intensive care units (ICUs) in 40 countries. These patients received mechanical ventilation for more than 12 h during 1-month periods in 1998, 2004, and 2010. We used multivariable logistic regression and a propensity score analysis to examine the association between hypercapnia and ICU mortality. We included 1899 patients with ARDS in this study. The relationship between maximum PaCO2 in the first 48 h and mortality suggests higher mortality at or above PaCO2 of ≥50 mmHg. Patients with severe hypercapnia (PaCO2 ≥50 mmHg) had higher complication rates, more organ failures, and worse outcomes. After adjusting for age, SAPS II score, respiratory rate, positive end-expiratory pressure, PaO2/FiO2 ratio, driving pressure, pressure/volume limitation strategy (PLS), corrected minute ventilation, and presence of acidosis, severe hypercapnia was associated with increased risk of ICU mortality [odds ratio (OR) 1.93, 95% confidence interval (CI) 1.32 to 2.81; p = 0.001]. In patients with severe hypercapnia matched for all other variables, ventilation with PLS was associated with higher ICU mortality (OR 1.58, CI 95% 1.04-2.41; p = 0.032). Severe hypercapnia appears to be independently associated with higher ICU mortality in patients with ARDS. Clinicaltrials.gov identifier, NCT01093482.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 060241913

Download citation: RISBibTeXText

PMID: 28108768

DOI: 10.1007/s00134-016-4611-1


Related references

Compliance and statistics : Discussion on "Severe hypercapnia and outcomes of mechanically ventilated patients with moderate or severe acute respiratory distress syndrome". Intensive Care Medicine 43(5): 724-725, 2017

The impact of cardiac dysfunction on acute respiratory distress syndrome and mortality in mechanically ventilated patients with severe sepsis and septic shock: an observational study. Journal of Critical Care 30(1): 65-70, 2015

Metabolic acid-base adaptation triggered by acute persistent hypercapnia in mechanically ventilated patients with acute respiratory distress syndrome. Revista Brasileira de Terapia Intensiva 28(1): 19-26, 2017

Early initiation of venovenous extracorporeal membrane oxygenation in a mechanically ventilated patient with severe acute respiratory distress syndrome. Bmj Case Reports 2018:, 2018

Angiopoietin-2 Levels as Predictors of Outcome in Mechanically Ventilated Patients with Acute Respiratory Distress Syndrome. Disease Markers 2017: 6758721, 2017

Permissive hypercapnia with and without expiratory washout in patients with severe acute respiratory distress syndrome. Anesthesiology 87(1): 6-17; Discussion 25a-26a, 1997

Physical therapy management of ventilated patients with acute respiratory distress syndrome or severe acute lung injury. PhysioTherapy Canada. Physiotherapie Canada 63(2): 191-198, 2011

Prone Positioning in Patients With Moderate and Severe Acute Respiratory Distress Syndrome. Survey of Anesthesiology 54(4): 162-163, 2010

Expiratory washout versus optimization of mechanical ventilation during permissive hypercapnia in patients with severe acute respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine 160(1): 77-85, 1999

Moderate/severe acute respiratory distress syndrome in patients with or without traumatic brain injury. Trauma 17(4): 274-281, 2015

Assessment of PaO₂/FiO₂ for stratification of patients with moderate and severe acute respiratory distress syndrome. Bmj Open 5(3): E006812, 2015

Serial measurements of troponin and echocardiography in patients with moderate-to-severe acute respiratory distress syndrome. Journal of Critical Care 33: 132-136, 2016

Patients with acute respiratory distress syndrome mechanically ventilated in prone position. Ugeskrift for Laeger 160(32): 4649-4650, 1998

Pulmonary fibrosis correlates with outcome in adult respiratory distress syndrome. A study in mechanically ventilated patients. Chest 107(1): 196-200, 1995

Prone positioning in patients with moderate and severe acute respiratory distress syndrome: a randomized controlled trial. JAMA 302(18): 1977-1984, 2009