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. 2023 Jul;67(6):779-787.
doi: 10.1111/aas.14233. Epub 2023 Mar 23.

PaCO2 trajectories in mechanically ventilated patients with COVID-19: A population-based cohort study

Ronan M G Berg  1   2   3   4 , Andreas Ronit  5 , Nicolai Haase  6 , Morten Hylander Møller  6   7 , Klaus T Kristiansen  7   8 , Trine Jonassen  8 , Christian Wamberg  9 , Anne Sofie Andreasen  7   10 , Thomas Mohr  11 , Morten H Bestle  7   12 , Vibeke L Jørgensen  13 , Niels R Hammer  14 , Anja U Mitchell  15 , Margit Smitt  16 , Anders Møller Greve  17 , Martin Erik Nyeland  18   19 , Britt Wang Jensen  20 , Anne Helms Andreasen  20 , Janne Petersen  20   21 , Espen Jimenez Solem  18 , Matilde Winther-Jensen  20 , Ronni R Plovsing  7   8
Affiliations

PaCO2 trajectories in mechanically ventilated patients with COVID-19: A population-based cohort study

Ronan M G Berg et al. Acta Anaesthesiol Scand. 2023 Jul.

Abstract

Objective: To identify PaCO2 trajectories and assess their associations with mortality in critically ill patients with coronavirus disease 2019 (COVID-19) during the first and second waves of the pandemic in Denmark.

Design: A population-based cohort study with retrospective data collection.

Patients: All COVID-19 patients were treated in eight intensive care units (ICUs) in the Capital Region of Copenhagen, Denmark, between March 1, 2020 and March 31, 2021.

Measurements: Data from the electronic health records were extracted, and latent class analyses were computed based on up to the first 3 weeks of mechanical ventilation to depict trajectories of PaCO2 levels. Multivariable Cox regression analyses were used to calculate adjusted hazard ratios (aHRs) for Simplified Acute Physiology Score 3, sex and age with 95% confidence intervals (CIs) for death according to PaCO2 trajectories.

Main results: In latent class trajectory models, including 25,318 PaCO2 measurements from 244 patients, three PaCO2 latent class trajectories were identified: a low isocapnic (Class I; n = 130), a high isocapnic (Class II; n = 80), as well as a progressively hypercapnic (Class III; n = 34) trajectory. Mortality was higher in Class II [aHR: 2.16 {1.26-3.68}] and Class III [aHR: 2.97 {1.63-5.40}]) compared to Class I (reference).

Conclusion: Latent class analysis of arterial blood gases in mechanically ventilated COVID-19 patients identified distinct PaCO2 trajectories, which were independently associated with mortality.

Keywords: critical illness; hypercapnia; latent class trajectory model; mechanical ventilation; respiratory failure.

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References

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