An observational study of end-tidal carbon dioxide trends in general anesthesia
An observational study of end-tidal carbon dioxide trends in general anesthesia
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DOI：
10.1007/s12630-018-1249-1
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发表时间：
2019-02-01
影响因子：
4.2
通讯作者：
Saager, Leif
中科院分区：
文献类型：
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作者：
Akkermans, Annemarie;van Waes, Judith A. R.;Saager, Leif
目的尽管越来越多的证据支持手术患者较高呼气末二氧化碳 (ETCO2) 水平的潜在益处，但仍然没有足够的数据来制定理想的术中 ETCO2 目标指南。由于尚不清楚目前使用的术中 ETCO2 水平以及这些水平是否随时间变化，我们使用多中心围手术期结果组数据库调查了实践模式。方法这项回顾性、观察性、多中心研究纳入了 2008 年 1 月至 2016 年 9 月期间接受非心胸手术全身麻醉的 317,445 名成年患者。主要结果是时间加权平均曲线下面积(TWA-AUC) 四个 ETCO2 阈值（< 28、< 35、< 45 和 > 45 mmHg）。此外，还研究了 ETCO2 中值。 Kruskal-Wallis 检验用于分析年份之间的差异。构建随机效应多变量逻辑回归模型来研究变异性。 结果 TWA-AUC 和中位 ETCO2 均显示 ETCO2 随着时间的推移略有增加，中位[四分位距] ETCO2 2008 年为 33 [31.0-35.0] mmHg，2016 年为 35 [33.0-38.0] mmHg（P
PurposeDespite growing evidence supporting the potential benefits of higher end-tidal carbon dioxide (ETCO2) levels in surgical patients, there is still insufficient data to formulate guidelines for ideal intraoperative ETCO2 targets. As it is unclear which intraoperative ETCO2 levels are currently used and whether these levels have changed over time, we investigated the practice pattern using the Multicenter Perioperative Outcomes Group database.MethodsThis 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 ETCO2 thresholds (< 28, < 35, < 45, and > 45 mmHg). Additionally, a median ETCO2 was studied. A Kruskal-Wallis test was used to analyse differences between years. Random-effect multivariable logistic regression models were constructed to study variability.ResultsBoth TWA-AUC and median ETCO2 showed a minimal increase in ETCO2 over time, with a median [interquartile range] ETCO2 of 33 [31.0-35.0] mmHg in 2008 and 35 [33.0-38.0] mmHg in 2016 (P