Correlation between the variability of arterial partial pressure of carbon dioxide (PaCO2) and the prognostic risk in patients with acute respiratory distress syndrome (ARDS) during mechanical ventilation

doi:10.3877/cma.j.issn.1674-6902.2025.02.004

Abstract

Abstract:

Objective

To analyze the correlation between the variability of arterial partial pressure of carbon dioxide （PaCO₂） and the prognostic risk in patients with acute respiratory distress syndrome （ARDS）during mechanical ventilation.

Methods

A total of 56 ARDS patients treated with mechanical ventilation in our hospital from January 2020 to August 2024 were selected as the study subjects. Twenty deceased cases were in the observation group and 36 survivors were in the control group. Demographic data，clinical outcomes，and laboratory indicators were collected. Changes in PaCO₂ during mechanical ventilation were recorded，with 28-day all-cause mortality as the primary clinical outcome. Cox regression analysis was used to assess the correlation between PaCO₂ variability and adverse prognosis.

Results

The observation group had，sequential organ failure assessment （SOFA） score of （9.92±2.45），acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ） score of （24.84±5.63），and PaO₂/FiO₂ of （191.38±22.89），which were significantly different from the control group，SOFA score（8.41±2.19），APACHE Ⅱscore（21.35±4.84），PaO₂/FiO₂（206.97±20.53）（P＜0.05）. No significant differences in PaCO₂ levels were observed between the two groups during mechanical ventilation and at 1 day post-ventilation （P＞0.05）. However，the observation group showed higher PaCO₂ levels at 2 days （40.09±1.77 ）mmHg and 3 days （44.21±1.53） mmHg post-ventilation compared to the control group （38.26±1.18）mmHg and （41.04±1.05 ）mmHg，respectively； P＜0.05）. PaCO₂ variability decreased over time，with the observation group exhibiting higher variability than the control group（P＜0.05）. Cox regression analysis revealed that SOFA score （HR=1.197，95%CI：1.002～1.429） and PaCO₂ variability （HR=1.315，95%CI： 1.141～1.514） were associated with adverse prognosis in ARDS （P＜0.05）.After adjusting for confounders，PaCO₂ variability remained significantly correlated with adverse prognosis （HR=1.323，95%CI： 1.153 ～1.518； P＜0.05）.

Conclusion

Persistent elevation of PaCO₂ during mechanical ventilation in ARDS patients is associated with increased mortality risk. Higher PaCO₂ variability correlates with greater adverse prognosis risk. Monitoring PaCO₂ variability may help reduce prognostic risk in ARDS.

Key words: Acute respiratory distress syndrome, Partial arterial pressure of carbon dioxide, Adverse prognosis risk, All-cause mortality, Risk factor

Peng Zhang, Manman Shi, Hui Ma, Jiaojiao Wu, Tun Zhao, Yingbin Zhang. Correlation between the variability of arterial partial pressure of carbon dioxide (PaCO2) and the prognostic risk in patients with acute respiratory distress syndrome (ARDS) during mechanical ventilation[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2025, 18(02): 226-230.

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URL: https://zhfbjbzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6902.2025.02.004

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Figures/Tables 4

临床特征	观察组（n=20）	对照组（n=36）	χ ²/t 值	P值
SOFA 评分［分，（ $\overset{ˉ}{x}$ ± s ）］	9.92±2.45	8.41±2.19	2.294	0.028
APACHE Ⅱ评分［分，（ $\overset{ˉ}{x}$ ± s ）］	24.84±5.63	21.35±4.84	2.334	0.026
ARDS 病因［n（％）］			2.103	0.147
肺内源性	14（38.89）	4（20.00）
肺外源性	22（61.11）	16（80.00）
基础疾病［n（％）］
高血压	10（50.00）	16（44.44）	0.160	0.690
糖尿病	9（45.00）	12（33.33）	0.747	0.388
高脂血症	6（30.00）	10（27.78）	0.031	0.860
冠心病	5（25.00）	6（16.67）	0.566	0.452
PaCO₂［（ $\overset{ˉ}{x}$ ± s ），mmHg］	37.72±6.16	38.26±7.42	0.292	0.772
PaO₂［mmHg，（ $\overset{ˉ}{x}$ ± s ）］	109.94±14.69	114.36±18.80	0.974	0.335
PaO₂ / FiO₂（ $\overset{ˉ}{x}$ ± s ）	191.38±22.89	206.97±20.53	2.532	0.016
心率［bpm，M（P₂₅，P₇₅）］	102（94，110）	100.00（87，102）	0.712	0.480
MAP［mmHg，（ $\overset{ˉ}{x}$ ± s ）］	84.71±10.58	86.35±9.43	0.577	0.567
支气管壁厚度［mm，（ $\overset{ˉ}{x}$ ± s ）］	3.14±0.56	3.02±0.52	0.788	0.436
肺实质渗出面积［cm²，（ $\overset{ˉ}{x}$ ± s ）］	12.04±2.23	10.87±2.61	1.768	0.084

临床特征	观察组（n=20）	对照组（n=36）	χ ²/t 值	P值
SOFA 评分［分，（ $\overset{ˉ}{x}$ ± s ）］	9.92±2.45	8.41±2.19	2.294	0.028
APACHE Ⅱ评分［分，（ $\overset{ˉ}{x}$ ± s ）］	24.84±5.63	21.35±4.84	2.334	0.026
ARDS 病因［n（％）］			2.103	0.147
肺内源性	14（38.89）	4（20.00）
肺外源性	22（61.11）	16（80.00）
基础疾病［n（％）］
高血压	10（50.00）	16（44.44）	0.160	0.690
糖尿病	9（45.00）	12（33.33）	0.747	0.388
高脂血症	6（30.00）	10（27.78）	0.031	0.860
冠心病	5（25.00）	6（16.67）	0.566	0.452
PaCO₂［（ $\overset{ˉ}{x}$ ± s ），mmHg］	37.72±6.16	38.26±7.42	0.292	0.772
PaO₂［mmHg，（ $\overset{ˉ}{x}$ ± s ）］	109.94±14.69	114.36±18.80	0.974	0.335
PaO₂ / FiO₂（ $\overset{ˉ}{x}$ ± s ）	191.38±22.89	206.97±20.53	2.532	0.016
心率［bpm，M（P₂₅，P₇₅）］	102（94，110）	100.00（87，102）	0.712	0.480
MAP［mmHg，（ $\overset{ˉ}{x}$ ± s ）］	84.71±10.58	86.35±9.43	0.577	0.567
支气管壁厚度［mm，（ $\overset{ˉ}{x}$ ± s ）］	3.14±0.56	3.02±0.52	0.788	0.436
肺实质渗出面积［cm²，（ $\overset{ˉ}{x}$ ± s ）］	12.04±2.23	10.87±2.61	1.768	0.084

组　别	例数	通气时	1 d 后	2 d 后	3 d 后	F值	P值
观察组	20	31.07±2.19	36.04±1.97	40.09±1.77	44.21±1.53	组别=68.422	0.000
对照组	36	31.44±1.23	35.38±1.40	38.26±1.18	41.04±1.05	时间=563.269	0.000
t 值		0.697	1.324	4.141	8.249	交互=9.065	0.000
P值		0.492	0.196	0.000	0.000

组　别	例数	CV1	CV2	CV3
观察组	20	17.63±0.72	16.00±1.05	11.24±0.76
对照组	36	17.82±0.84	12.53±0.69	8.14±0.42
t 值		0.891	13.273	16.867
P值		0.378	0.000	0.000

变　量	校正前						校正后
	β	标准误	Wald	P值	HR	95％CI		β	标准误	Wald	P值	HR	95％CI
	β	标准误	Wald	P值	HR	下限	上限	β	标准误	Wald	P值	HR	下限	上限
年龄	0.026	0.019	1.854	0.173	1.026	0.989	1.065	0.022	0.019	1.371	0.242	1.022	0.985	1.060
SOFA 评分	0.18	0.091	3.936	0.047	1.197	1.002	1.429	0.080	0.095	0.704	0.402	1.083	0.899	1.306
APACHE Ⅱ评分	0.039	0.033	1.375	0.241	1.040	0.974	1.109	0.050	0.034	2.157	0.142	1.051	0.984	1.123
PaO₂ / FiO₂	-0.009	0.007	1.596	0.206	0.991	0.977	1.005	-0.004	0.007	0.347	0.556	0.996	0.981	1.010
PaCO₂ 水平	-0.049	0.043	1.264	0.261	0.952	0.875	1.037	-0.053	0.043	1.477	0.224	0.949	0.871	1.033
PaCO₂变异率	0.274	0.072	14.401	0	1.315	1.141	1.514	0.280	0.070	15.836	0	1.323	1.153	1.518

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