Surgery · 2 h ago
Low Intraoperative End-Tidal CO₂ Linked to Mortality After Noncardiac Surgery
A retrospective cohort study of 185,455 adults undergoing noncardiac surgery found that lower intraoperative end-tidal carbon dioxide was associated with higher in-hospital mortality. The association remained after adjustment for minute ventilation and hypotension, but the observational findings do not establish causality.
- Cohort included 185,455 adults undergoing noncardiac surgery.
- Lower ETCO₂ was associated with higher in-hospital mortality.
- Association persisted after adjustment for ventilation and hypotension.
- Retrospective findings do not establish causality.
Researchers analyzed records for 185,455 adults who underwent noncardiac surgery under general anesthesia with mechanical ventilation at a tertiary care center from 2010 to 2020. The study examined mean intraoperative end-tidal carbon dioxide (ETCO₂), minute ventilation, and the severity and duration of hypotension in relation to in-hospital mortality. Mortality in the cohort was 0.85%; multivariable logistic regression was used to assess the association between ETCO₂ and death.
Lower ETCO₂ was nonlinearly associated with increased mortality after adjustment for minute ventilation, hypotension, and predefined confounders. For each 5-mmHg decrease from the median ETCO₂, the adjusted odds ratio was 1.63 (95% CI, 1.36–1.86). The association did not significantly interact with hypotension (P=0.19), and findings were consistent across sensitivity analyses.
The results suggest ETCO₂ may provide prognostic information beyond blood pressure and ventilation measures in this setting. However, the retrospective, single-center design cannot establish that low ETCO₂ causes mortality or determine the underlying mechanism. The findings support further evaluation of ETCO₂ for risk stratification, not a change in intraoperative management on their own.
In practice
For adults undergoing noncardiac surgery under general anesthesia with mechanical ventilation, lower intraoperative ETCO₂ was associated with higher in-hospital mortality in a cohort of 185,455 patients, even after adjustment for minute ventilation and hypotension. This may make ETCO₂ a candidate prognostic marker alongside conventional intraoperative measures. Because the evidence is retrospective and from one tertiary center, it does not show that changing ETCO₂ improves outcomes or justify altering ventilation or hemodynamic management.
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Anesthesiology: Association of Intraoperative End-tidal Carbon Dioxide, Ventilation, and Hypotension with Postoperative Mortality in Noncardiac Surgery: A Retrospective Cohort Study ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.