Association between intraoperative end-tidal carbon dioxide and postoperative organ dysfunction in major abdominal surgery: A cohort study

Abstract

BackgroundData on the effects of intraoperative end-tidal carbon dioxide (EtCO2) levels on postoperative organ dysfunction are limited. Thus, this study was designed to investigate the relationship between the intraoperative EtCO2level and postoperative organ dysfunction in patients who underwent major abdominal surgery under general anesthesia.MethodsWe conducted a cohort study involving patients who underwent major abdominal surgery under general anesthesia at Kyoto University Hospital. We classified those with a mean EtCO2of less than 35 mmHg as low EtCO2. The time effect was determined as the minutes when the EtCO2value was below 35 mmHg, whereas the cumulative effect was evaluated by measuring the area below the 35-mmHg threshold. The outcome was postoperative organ dysfunction, defined as a composite of at least one organ dysfunction among acute renal injury, circulatory dysfunction, respiratory dysfunction, coagulation dysfunction, and liver dysfunction within 7 days after surgery.ResultsOf the 4,171 patients, 1,195 (28%) had low EtCO2, and 1,428 (34%) had postoperative organ dysfunction. An association was found between low EtCO2and increased postoperative organ dysfunction (adjusted risk ratio, 1.11; 95% confidence interval [CI], 1.03–1.20;p= 0.006). Additionally, long-term exposure to EtCO2values of less than 35 mmHg (≥224 min) was associated with postoperative organ dysfunction (adjusted risk ratio, 1.18; 95% CI, 1.06–1.32;p= 0.003) and low EtCO2severity (area under the threshold) (adjusted risk ratio, 1.13; 95% CI, 1.02–1.26;p= 0.018).ConclusionsIntraoperative low EtCO2of below 35 mmHg was associated with increased postoperative organ dysfunction.