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. 2023 May;68(5):582-591.
doi: 10.4187/respcare.10507. Epub 2023 Mar 28.

Impact of Arterial CO2 Retention in Patients With Moderate or Severe ARDS

Adel Maamar  1   2 , Flora Delamaire  1   2 , Florian Reizine  1   2   3 , Mathieu Lesouhaitier  1   2   3 , Benoit Painvin  1   2 , Quentin Quelven  1   2 , Valentin Coirier  1   2 , Pauline Guillot  1   2 , Yves Le Tulzo  1   2   3 , Jean Marc Tadié  1   2   3 , Arnaud Gacouin  4   2   3
Affiliations

Impact of Arterial CO2 Retention in Patients With Moderate or Severe ARDS

Adel Maamar et al. Respir Care. 2023 May.

Abstract

Background: Lung-protective ventilation (reduced tidal volume and limited plateau pressure) may lead to CO2 retention. Data about the impact of hypercapnia in patients with ARDS are scarce and conflicting.

Methods: We performed a non-interventional cohort study with subjects with ARDS admitted from 2006 to 2021 and with PaO2 /FIO2 ≤ 150 mm Hg. We examined the association between severe hypercapnia (PaCO2 ≥ 50 mm Hg) on the first 5 days after the diagnosis of ARDS and death in ICU for 930 subjects. All the subjects received lung-protective ventilation.

Results: Severe hypercapnia was noted in 552 subjects (59%) on the first day of ARDS (day 1); 323/930 (34.7%) died in the ICU. Severe hypercapnia on day 1 was associated with mortality in the unadjusted (odds ratio 1.54, 95% CI 1.16-1.63; P = .003) and adjusted (odds ratio 1.47, 95% CI 1.08-2.43; P = .004) models. In the Bayesian analysis, the posterior probability that severe hypercapnia was associated with ICU death was > 90% in 4 different priors, including a septic prior for this association. Sustained severe hypercapnia on day 5, defined as severe hypercapnia present from day 1 to day 5, was noted in 93 subjects (12%). After propensity score matching, severe hypercapnia on day 5 remained associated with ICU mortality (odds ratio 1.73, 95% CI 1.02-2.97; P = .047).

Conclusions: Severe hypercapnia was associated with mortality in subjects with ARDS who received lung-protective ventilation. Our results deserve further evaluation of the strategies and treatments that aim to control CO2 retention.

Keywords: ARDS; cohort study; hypercapnia; mortality.

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Conflict of interest statement

The authors have disclosed no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Diagram flowchart of patients.
Fig. 2.
Fig. 2.
A: Density probability function of PaCO2 stratified by plateau pressure. B: PaCO2 locally estimated scatterplot smoothing curves of the relationship between ICU mortality and PaCO2 on day 1 of ARDS.
Fig. 3.
Fig. 3.
Subjects compared for ICU mortality rates based on whether sustained severe hypercapnia was noted on each of the first 5 days after ARDS diagnosis.
See this image and copyright information in PMC

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