tetano
Editor, Senior Moderator
J Crit Care
. 2022 Mar 24;69:154022.
doi: 10.1016/j.jcrc.2022.154022. Online ahead of print.
Clinical characteristics, physiological features, and outcomes associated with hypercapnia in patients with acute hypoxemic respiratory failure due to COVID-19---insights from the PRoVENT-COVID study
Anissa M Tsonas[SUP] 1 [/SUP], Michela Botta[SUP] 2 [/SUP], Janneke Horn[SUP] 3 [/SUP], Luis Morales-Quinteros[SUP] 4 [/SUP], Antonio Artigas[SUP] 5 [/SUP], Marcus J Schultz[SUP] 6 [/SUP], Frederique Paulus[SUP] 7 [/SUP], Ary Serpa Neto[SUP] 8 [/SUP], PRoVENT-COVID Collaborative Group
Affiliations
Abstract
Purpose: We determined the incidence of hypercapnia and associations with outcome in invasively ventilated COVID-19 patients.
Methods: Posthoc analysis of a national, multicenter, observational study in 22 ICUs. Patients were classified as 'hypercapnic' or 'normocapnic' in the first three days of invasive ventilation. Primary endpoint was prevalence of hypercapnia. Secondary endpoints were ventilator parameters, length of stay (LOS) in ICU and hospital, and mortality in ICU, hospital, at day 28 and 90.
Results: Of 824 patients, 485 (58.9%) were hypercapnic. Hypercapnic patients had a higher BMI and had COPD, severe ARDS and venous thromboembolic events more often. Hypercapnic patients were ventilated with lower tidal volumes, higher respiratory rates, higher driving pressures, and with more mechanical power of ventilation. Hypercapnic patients had comparable minute volumes but higher ventilatory ratios than normocapnic patients. In hypercapnic patients, ventilation and LOS in ICU and hospital was longer, but mortality was comparable to normocapnic patients.
Conclusion: Hypercapnia occurs often in invasively ventilated COVID-19 patients. Main differences between hypercapnic and normocapnic patients are severity of ARDS, occurrence of venous thromboembolic events, and a higher ventilation ratio. Hypercapnia has an association with duration of ventilation and LOS in ICU and hospital, but not with mortality.
Keywords: ARDS; CO2 management; COVID-19; Coronavirus disease 2019; Hypercapnia; Invasive ventilation; Sustained hypercapnia; Ventilation.
. 2022 Mar 24;69:154022.
doi: 10.1016/j.jcrc.2022.154022. Online ahead of print.
Clinical characteristics, physiological features, and outcomes associated with hypercapnia in patients with acute hypoxemic respiratory failure due to COVID-19---insights from the PRoVENT-COVID study
Anissa M Tsonas[SUP] 1 [/SUP], Michela Botta[SUP] 2 [/SUP], Janneke Horn[SUP] 3 [/SUP], Luis Morales-Quinteros[SUP] 4 [/SUP], Antonio Artigas[SUP] 5 [/SUP], Marcus J Schultz[SUP] 6 [/SUP], Frederique Paulus[SUP] 7 [/SUP], Ary Serpa Neto[SUP] 8 [/SUP], PRoVENT-COVID Collaborative Group
Affiliations
- PMID: 35339900
- DOI: 10.1016/j.jcrc.2022.154022
Abstract
Purpose: We determined the incidence of hypercapnia and associations with outcome in invasively ventilated COVID-19 patients.
Methods: Posthoc analysis of a national, multicenter, observational study in 22 ICUs. Patients were classified as 'hypercapnic' or 'normocapnic' in the first three days of invasive ventilation. Primary endpoint was prevalence of hypercapnia. Secondary endpoints were ventilator parameters, length of stay (LOS) in ICU and hospital, and mortality in ICU, hospital, at day 28 and 90.
Results: Of 824 patients, 485 (58.9%) were hypercapnic. Hypercapnic patients had a higher BMI and had COPD, severe ARDS and venous thromboembolic events more often. Hypercapnic patients were ventilated with lower tidal volumes, higher respiratory rates, higher driving pressures, and with more mechanical power of ventilation. Hypercapnic patients had comparable minute volumes but higher ventilatory ratios than normocapnic patients. In hypercapnic patients, ventilation and LOS in ICU and hospital was longer, but mortality was comparable to normocapnic patients.
Conclusion: Hypercapnia occurs often in invasively ventilated COVID-19 patients. Main differences between hypercapnic and normocapnic patients are severity of ARDS, occurrence of venous thromboembolic events, and a higher ventilation ratio. Hypercapnia has an association with duration of ventilation and LOS in ICU and hospital, but not with mortality.
Keywords: ARDS; CO2 management; COVID-19; Coronavirus disease 2019; Hypercapnia; Invasive ventilation; Sustained hypercapnia; Ventilation.