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Associations of arterial carbon dioxide and arterial oxygen concentrations with hospital mortality after resuscitation from cardiac arrest.

Helmerhorst HJ, Roos-Blom MJ, van Westerloo DJ, Abu-Hanna A, de Keizer NF, de Jonge E - Crit Care (2015)

Bottom Line: Our aim was to investigate the independent and synergistic effects of both parameters on hospital mortality.Hypoxia and hyperoxia were observed in 8 % and 3 % of the patients, respectively.The effects of aberrant arterial carbon dioxide and arterial oxygen concentrations were independently but not synergistically associated with hospital mortality after cardiac arrest.

View Article: PubMed Central - PubMed

Affiliation: Department of Intensive Care Medicine, Leiden University Medical Center, Post Box 9600, Leiden, 2300 RC, The Netherlands. H.J.F.Helmerhorst@lumc.nl.

ABSTRACT

Introduction: Arterial concentrations of carbon dioxide (PaCO2) and oxygen (PaO2) during admission to the intensive care unit (ICU) may substantially affect organ perfusion and outcome after cardiac arrest. Our aim was to investigate the independent and synergistic effects of both parameters on hospital mortality.

Methods: This was a cohort study using data from mechanically ventilated cardiac arrest patients in the Dutch National Intensive Care Evaluation (NICE) registry between 2007 and 2012. PaCO2 and PaO2 levels from arterial blood gas analyses corresponding to the worst oxygenation in the first 24 h of ICU stay were retrieved for analyses. Logistic regression analyses were performed to assess the relationship between hospital mortality and both categorized groups and a spline-based transformation of the continuous values of PaCO2 and PaO2.

Results: In total, 5,258 cardiac arrest patients admitted to 82 ICUs in the Netherlands were included. In the first 24 h of ICU admission, hypocapnia was encountered in 22 %, and hypercapnia in 35 % of included cases. Hypoxia and hyperoxia were observed in 8 % and 3 % of the patients, respectively. Both PaCO2 and PaO2 had an independent U-shaped relationship with hospital mortality and after adjustment for confounders, hypocapnia and hypoxia were significant predictors of hospital mortality: OR 1.37 (95 % CI 1.17-1.61) and OR 1.34 (95 % CI 1.08-1.66). A synergistic effect of concurrent derangements of PaCO2 and PaO2 was not observed (P = 0.75).

Conclusions: The effects of aberrant arterial carbon dioxide and arterial oxygen concentrations were independently but not synergistically associated with hospital mortality after cardiac arrest.

No MeSH data available.


Related in: MedlinePlus

Adjusted probability of in-hospital death by arterial oxygen levels. Loess smoothing curve predicted from logistic regression model adjusted for spline functions of age, lowest glucose, AP4-adj and PaCO2. Grey zones represent 95 % confidence intervals
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Fig2: Adjusted probability of in-hospital death by arterial oxygen levels. Loess smoothing curve predicted from logistic regression model adjusted for spline functions of age, lowest glucose, AP4-adj and PaCO2. Grey zones represent 95 % confidence intervals

Mentions: Both PaCO2 and PaO2 showed a curvilinear U-shaped relationship with mortality in adjusted analyses (Figs. 1 and 2). Odds ratios from multivariate analyses are listed in Table 3. After adjustment for age, lowest glucose, AP4-adj and PaO2 (splines), hypocapnia showed a significant association with hospital mortality (P < 0.001), whereas hypercapnia did not. When this model was reanalyzed without adjustment for PaO2, the results were virtually unchanged (data not shown).Fig. 1


Associations of arterial carbon dioxide and arterial oxygen concentrations with hospital mortality after resuscitation from cardiac arrest.

Helmerhorst HJ, Roos-Blom MJ, van Westerloo DJ, Abu-Hanna A, de Keizer NF, de Jonge E - Crit Care (2015)

Adjusted probability of in-hospital death by arterial oxygen levels. Loess smoothing curve predicted from logistic regression model adjusted for spline functions of age, lowest glucose, AP4-adj and PaCO2. Grey zones represent 95 % confidence intervals
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4587673&req=5

Fig2: Adjusted probability of in-hospital death by arterial oxygen levels. Loess smoothing curve predicted from logistic regression model adjusted for spline functions of age, lowest glucose, AP4-adj and PaCO2. Grey zones represent 95 % confidence intervals
Mentions: Both PaCO2 and PaO2 showed a curvilinear U-shaped relationship with mortality in adjusted analyses (Figs. 1 and 2). Odds ratios from multivariate analyses are listed in Table 3. After adjustment for age, lowest glucose, AP4-adj and PaO2 (splines), hypocapnia showed a significant association with hospital mortality (P < 0.001), whereas hypercapnia did not. When this model was reanalyzed without adjustment for PaO2, the results were virtually unchanged (data not shown).Fig. 1

Bottom Line: Our aim was to investigate the independent and synergistic effects of both parameters on hospital mortality.Hypoxia and hyperoxia were observed in 8 % and 3 % of the patients, respectively.The effects of aberrant arterial carbon dioxide and arterial oxygen concentrations were independently but not synergistically associated with hospital mortality after cardiac arrest.

View Article: PubMed Central - PubMed

Affiliation: Department of Intensive Care Medicine, Leiden University Medical Center, Post Box 9600, Leiden, 2300 RC, The Netherlands. H.J.F.Helmerhorst@lumc.nl.

ABSTRACT

Introduction: Arterial concentrations of carbon dioxide (PaCO2) and oxygen (PaO2) during admission to the intensive care unit (ICU) may substantially affect organ perfusion and outcome after cardiac arrest. Our aim was to investigate the independent and synergistic effects of both parameters on hospital mortality.

Methods: This was a cohort study using data from mechanically ventilated cardiac arrest patients in the Dutch National Intensive Care Evaluation (NICE) registry between 2007 and 2012. PaCO2 and PaO2 levels from arterial blood gas analyses corresponding to the worst oxygenation in the first 24 h of ICU stay were retrieved for analyses. Logistic regression analyses were performed to assess the relationship between hospital mortality and both categorized groups and a spline-based transformation of the continuous values of PaCO2 and PaO2.

Results: In total, 5,258 cardiac arrest patients admitted to 82 ICUs in the Netherlands were included. In the first 24 h of ICU admission, hypocapnia was encountered in 22 %, and hypercapnia in 35 % of included cases. Hypoxia and hyperoxia were observed in 8 % and 3 % of the patients, respectively. Both PaCO2 and PaO2 had an independent U-shaped relationship with hospital mortality and after adjustment for confounders, hypocapnia and hypoxia were significant predictors of hospital mortality: OR 1.37 (95 % CI 1.17-1.61) and OR 1.34 (95 % CI 1.08-1.66). A synergistic effect of concurrent derangements of PaCO2 and PaO2 was not observed (P = 0.75).

Conclusions: The effects of aberrant arterial carbon dioxide and arterial oxygen concentrations were independently but not synergistically associated with hospital mortality after cardiac arrest.

No MeSH data available.


Related in: MedlinePlus