Neuroanesthesia & neurocritical care
Clinical practice and effect of carbon dioxide on outcomes in mechanically ventilated acute brain-injured patients: a secondary analysis of the ENIO study
An erratum to this article was published (Intensive Care Med, Feb 2024 ↗)
Authors' conclusion
Normocapnia and mild hypocapnia are common in ABI patients and do not affect patients' outcome. Extreme derangements of PaCO2 values were significantly associated with increased in-hospital mortality.
Study context
- Population
- Adult invasively ventilated intensive care unit (ICU) patients with traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), intracranial hemorrhage or ischemic stroke
- Participants
- 1,476 participants
- Comparison
- PaCO2 categories
- Normocapnian = 804
- Mild hypocapnian = 125
- Severe hypocapnian = 334
- Forced hypocapnian = 40
- Hypercapnian = 173
- Primary endpoint
- PaCO2 targets and occurrence of abnormal PaCO2 values (days 1, 3 and 7)
- Follow-up
- First week in ICU
Methodological detailsmulticentre
- Multicentre
Primary result
As reported in the abstract
PaCO2 category on ICU admission · ICU admission
- Normocapnic
- 804 (54.5%)
- Normocapnia incidence during ICU stay (episodes per person/day)
- 1.37
- Mild hypocapnic
- 125 (8.5%)
- Mild hypocapnia incidence (episodes/day)
- 0.52
- Severe hypocapnic
- 334 (22.6%)
- Severe hypocapnia incidence (episodes/day)
- 0.25
- Forced hypocapnia used
- 40 (2.7%)
- Hypercapnia used
- 173 (11.7%)
Further findings
In-hospital mortality
- U-shaped relationship of PaCO2 with in-hospital mortality; only severe hypocapnia and hypercapnia associated with increased probability of in-hospital mortality
- omnibus p value = 0.0009
In-hospital mortality by acute brain injured (ABI) subgroup (subgroup)
- Important differences across ABI subgroups
Original publication
Clinical practice and effect of carbon dioxide on outcomes in mechanically ventilated acute brain-injured patients: a secondary analysis of the ENIO study. Intensive Care Med. Published 31 January 2024. doi:10.
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