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Title: Clinical characteristics, physiological features, and outcomes associated with hypercapnia in patients with acute hypoxemic respiratory failure due to COVID-19---insights from the PRoVENT-COVID study.
Austin Authors: Tsonas, Anissa M;Botta, Michela;Horn, Janneke;Morales-Quinteros, Luis;Artigas, Antonio;Schultz, Marcus J;Paulus, Frederique;Serpa Neto, Ary 
Affiliation: Department of Critical Care, Melbourne Medical School, Austin Hospital and University of Melbourne, Melbourne, Australia..
Data Analytics Research and Evaluation (DARE) Centre
Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil..
Department of Intensive Care, Amsterdam UMC, location 'AMC', Amsterdam, the Netherlands..
Amsterdam Neuroscience, Amsterdam UMC, location 'AMC', Amsterdam, the Netherlands..
Intensive Care Unit, University General Hospital of Catalonia, Barcelona, Spain..
The Autonomous University of Barcelona, Barcelona, Spain..
Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand..
ACHIEVE, Centre of Applied Research, Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, the Netherlands..
Department of Critical Care Medicine, Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia..
Servei de Medicina Intensive, Hospital Universitari Sant Pau, Barcelona, Spain..
The Autonomous University of Barcelona, Barcelona, Spain..
The Parc TaulĂ­ Research and Innovation Institute (I3PT), Sabadell, Spain..
Critical Care Center, University Hospital Parc Tauli, Sabadell, Spain..
CIBER Enfermedades Respiratorias (ISCiii), Madrid, Spain..
Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom..
Issue Date: Jun-2022
Date: 2022-03-24
Publication information: Journal of Critical Care 2022; 69: 154022
Abstract: We determined the incidence of hypercapnia and associations with outcome in invasively ventilated COVID-19 patients. Posthoc analysis of a national, multicenter, observational study in 22 ICUs. Patients were classified as 'hypercapnic' or 'normocapnic' in the first three days of invasive ventilation. Primary endpoint was prevalence of hypercapnia. Secondary endpoints were ventilator parameters, length of stay (LOS) in ICU and hospital, and mortality in ICU, hospital, at day 28 and 90. Of 824 patients, 485 (58.9%) were hypercapnic. Hypercapnic patients had a higher BMI and had COPD, severe ARDS and venous thromboembolic events more often. Hypercapnic patients were ventilated with lower tidal volumes, higher respiratory rates, higher driving pressures, and with more mechanical power of ventilation. Hypercapnic patients had comparable minute volumes but higher ventilatory ratios than normocapnic patients. In hypercapnic patients, ventilation and LOS in ICU and hospital was longer, but mortality was comparable to normocapnic patients. Hypercapnia occurs often in invasively ventilated COVID-19 patients. Main differences between hypercapnic and normocapnic patients are severity of ARDS, occurrence of venous thromboembolic events, and a higher ventilation ratio. Hypercapnia has an association with duration of ventilation and LOS in ICU and hospital, but not with mortality.
DOI: 10.1016/j.jcrc.2022.154022
ORCID: 0000-0003-1520-9387
Journal: Journal of critical care
PubMed URL: 35339900
PubMed URL:
Type: Journal Article
Subjects: ARDS
CO2 management
Coronavirus disease 2019
Invasive ventilation
Sustained hypercapnia
Appears in Collections:Journal articles

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