代谢性酸中毒重症患者轻度高碳酸血症的影响。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care Pub Date : 2024-10-20 DOI:10.1016/j.jcrc.2024.154936

Ary Serpa Neto , Ahmad Nasser , Prashanti Marella , Tomoko Fujii , Kazunari Takahashi , Kevin Laupland , Alexis Tabah , Antony G. Attokaran , Aashish Kumar , James McCullough , Kiran Shekar , Peter Garrett , Sebastiaan Blank , Siva Senthuran , Stephen Luke , Mairead McNamara , Rinaldo Bellomo , Kyle White , on behalf of the Queensland Critical Care Research Network (QCCRN) and the SODa-BIC investigators

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引用次数: 0

摘要

目的：针对代谢性酸中毒重症患者的临床试验，一个常见的排除标准是 PaCO2 > 45 mmHg。本研究旨在评估轻度高碳酸血症对代谢性酸中毒重症患者的特征、严重程度和临床结果的影响：在澳大利亚昆士兰州的 12 个重症监护病房（ICU）开展多中心、回顾性、观察性研究。研究纳入了代谢性酸中毒且同时需要血管加压素的患者，研究对象为符合资格标准时的 PaCO2 水平，分为两组：PaCO2 ≤ 45 mmHg 和 PaCO2 46-50 mmHg。主要临床结果为 30 天内的主要肾脏不良事件（MAKE30）：我们对 5601 名患者进行了研究，其中 PaCO2 ≤ 45 mmHg 组有 3605 人（64.4%），PaCO2 46-50 mmHg 组有 1996 人（35.6%）。PaCO2 46-50 mmHg 组的 MAKE30 发生率较低（29 % vs. 34 %；OR，0.79 [95 %CI，0.69 至 0.90]；PaCO2 46-50 mmHg 组的 P 2 为 0.006）：在代谢性酸中毒患者中，经调整潜在的混杂因素后，轻度高碳酸血症不会增加 MAKE-30 的速率，也不会对 pH 值产生重大影响。

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Impact of mild hypercapnia in critically ill patients with metabolic acidosis

Purpose

Clinical trials focusing on critically ill patients with metabolic acidosis, a common exclusion criterion is the presence of a PaCO₂ > 45 mmHg. The aim of this study was to assess the impact of mild hypercapnia on patient characteristics, severity, and clinical outcomes in critically ill patients with metabolic acidosis.

Material and methods

Multicentre, retrospective, observational study conducted in 12 intensive care units (ICUs) in Queensland, Australia. Patients with metabolic acidosis and concurrent vasopressor requirement were included and the exposure of interest was the PaCO₂ level at the time of meeting the eligibility criteria divided in two groups: PaCO₂ ≤ 45 mmHg and PaCO₂ 46–50 mmHg. Primary clinical outcome was major adverse kidney events within 30 days (MAKE30).

Results

We studied 5601 patients, with 3605 (64.4 %) in the PaCO₂ ≤ 45 mmHg group and 1996 (35.6 %) in the PaCO₂ 46–50 mmHg group. The incidence of MAKE30 was lower in the PaCO₂ 46–50 mmHg group (29 % vs. 34 %; OR, 0.79 [95 %CI, 0.69 to 0.90]; p < 0.001) as was the use of renal replacement therapy, and the incidence of acute kidney injury. After adjustment for confounders, no outcome was different between the groups. The maximum fall of pH associated with an increase of 1 mmHg of PaCO₂ in the PaCO₂ 46–50 mmHg group was 0.006.

Conclusion

In patients with metabolic acidosis, after adjustment for potential confounders, mild hypercapnia does not increase the MAKE-30 rate and does not have a major impact on pH.

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来源期刊

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.