Étude observationnelle sur les tendances des valeurs du dioxyde de carbone en fin d’expiration au cours de l’anesthésie générale

Translated title of the contribution: An observational study of end-tidal carbon dioxide trends in general anesthesia

Annemarie Akkermans, Judith A.R. van Waes, Aleda Thompson, Amy Shanks, Linda M. Peelen, Michael Aziz, Daniel A. Biggs, William C. Paganelli, Jonathan P. Wanderer, Daniel L. Helsten, Sachin Kheterpal, Wilton A. van Klei, Leif Saager

Research output: Contribution to journalArticle

Abstract

Purpose: Despite 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. 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 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. Results: Both 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 <0.001). A large inter-hospital and inter-provider variability in ETCO2 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 ETCO2 values did not change in a clinically important manner. Interestingly, we found a large inter-hospital and inter-provider variability in ETCO2 throughout the study period, possibly indicating a broad range of tolerance for ETCO2, 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.

Original languageFrench
JournalCanadian Journal of Anesthesia
DOIs
StateAccepted/In press - Jan 1 2018

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Carbon Dioxide
General Anesthesia
Observational Studies
Area Under Curve
Logistic Models
Multicenter Studies
Ventilation
Databases
Guidelines
Confidence Intervals
Blood Pressure

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Étude observationnelle sur les tendances des valeurs du dioxyde de carbone en fin d’expiration au cours de l’anesthésie générale. / Akkermans, Annemarie; van Waes, Judith A.R.; Thompson, Aleda; Shanks, Amy; Peelen, Linda M.; Aziz, Michael; Biggs, Daniel A.; Paganelli, William C.; Wanderer, Jonathan P.; Helsten, Daniel L.; Kheterpal, Sachin; van Klei, Wilton A.; Saager, Leif.

In: Canadian Journal of Anesthesia, 01.01.2018.

Research output: Contribution to journalArticle

Akkermans, A, van Waes, JAR, Thompson, A, Shanks, A, Peelen, LM, Aziz, M, Biggs, DA, Paganelli, WC, Wanderer, JP, Helsten, DL, Kheterpal, S, van Klei, WA & Saager, L 2018, 'Étude observationnelle sur les tendances des valeurs du dioxyde de carbone en fin d’expiration au cours de l’anesthésie générale', Canadian Journal of Anesthesia. https://doi.org/10.1007/s12630-018-1249-1
Akkermans, Annemarie ; van Waes, Judith A.R. ; Thompson, Aleda ; Shanks, Amy ; Peelen, Linda M. ; Aziz, Michael ; Biggs, Daniel A. ; Paganelli, William C. ; Wanderer, Jonathan P. ; Helsten, Daniel L. ; Kheterpal, Sachin ; van Klei, Wilton A. ; Saager, Leif. / Étude observationnelle sur les tendances des valeurs du dioxyde de carbone en fin d’expiration au cours de l’anesthésie générale. In: Canadian Journal of Anesthesia. 2018.
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abstract = "Purpose: Despite 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. 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 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. Results: Both 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 <0.001). A large inter-hospital and inter-provider variability in ETCO2 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 ETCO2 values did not change in a clinically important manner. Interestingly, we found a large inter-hospital and inter-provider variability in ETCO2 throughout the study period, possibly indicating a broad range of tolerance for ETCO2, 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.",
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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

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

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