{"id":24283,"date":"2023-07-25T04:40:00","date_gmt":"2023-07-24T20:40:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=24283"},"modified":"2023-07-25T05:49:08","modified_gmt":"2023-07-24T21:49:08","slug":"nejm%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e9%99%a2%e5%a4%96%e5%bf%83%e8%b7%b3%e9%aa%a4%e5%81%9c%e5%90%8e%e8%bd%bb%e5%ba%a6co2%e6%bd%b4%e7%95%99%e6%88%96%e8%a1%80%e7%a2%b3%e9%85%b8%e6%ad%a3","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=24283","title":{"rendered":"[NEJM\u53d1\u8868\u8bba\u6587]\uff1a\u9662\u5916\u5fc3\u8df3\u9aa4\u505c\u540e\u8f7b\u5ea6CO2\u6f74\u7559\u6216\u8840\u78b3\u9178\u6b63\u5e38"},"content":{"rendered":"\n<p><a href=\"https:\/\/www.nejm.org\/medical-articles\/original-article\" class=\"\">ORIGINAL ARTICLE<\/a><\/p>\n\n\n\n<h1 class=\"wp-block-heading\">Mild Hypercapnia or Normocapnia after Out-of-Hospital Cardiac Arrest<\/h1>\n\n\n\n<h3 class=\"wp-block-heading\">Glenn Eastwood, Alistair D. Nichol, Carol Hodgson,&nbsp;et al<\/h3>\n\n\n\n<h3 class=\"wp-block-heading\">N Engl J Med June 15, 2023<br \/>DOI: 10.1056\/NEJMoa2214552<\/h3>\n\n\n\n<h2 class=\"wp-block-heading\">Abstract<\/h2>\n\n\n\n<h2 class=\"wp-block-heading\">BACKGROUND<\/h2>\n\n\n\n<p>Guidelines recommend normocapnia for adults with coma who are resuscitated after out-of-hospital cardiac arrest. However, mild hypercapnia increases cerebral blood flow and may improve neurologic outcomes.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">METHODS<\/h2>\n\n\n\n<p>We randomly assigned adults with coma who had been resuscitated after out-of-hospital cardiac arrest of presumed cardiac or unknown cause and admitted to the intensive care unit (ICU) in a 1:1 ratio to either 24 hours of mild hypercapnia (target partial pressure of arterial carbon dioxide [Paco<sub>2<\/sub>], 50 to 55 mm Hg) or normocapnia (target Paco<sub>2<\/sub>, 35 to 45 mm Hg). The primary outcome was a favorable neurologic outcome, defined as a score of 5 (indicating lower moderate disability) or higher, as assessed with the use of the Glasgow Outcome Scale\u2013Extended (range, 1 [death] to 8, with higher scores indicating better neurologic outcome) at 6 months. Secondary outcomes included death within 6 months.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">RESULTS<\/h2>\n\n\n\n<p>A total of 1700 patients from 63 ICUs in 17 countries were recruited, with 847 patients assigned to targeted mild hypercapnia and 853 to targeted normocapnia. A favorable neurologic outcome at 6 months occurred in 332 of 764 patients (43.5%) in the mild hypercapnia group and in 350 of 784 (44.6%) in the normocapnia group (relative risk, 0.98; 95% confidence interval [CI], 0.87 to 1.11; P=0.76). Death within 6 months after randomization occurred in 393 of 816 patients (48.2%) in the mild hypercapnia group and in 382 of 832 (45.9%) in the normocapnia group (relative risk, 1.05; 95% CI, 0.94 to 1.16). The incidence of adverse events did not differ significantly between groups.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/www.nejm.org\/na101\/home\/literatum\/publisher\/mms\/journals\/content\/nejm\/2023\/nejm_2023.389.issue-1\/nejmoa2214552\/20230703\/images\/img_xlarge\/nejmoa2214552_f0.jpeg\" alt=\"\"\/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/www.nejm.org\/na101\/home\/literatum\/publisher\/mms\/journals\/content\/nejm\/2023\/nejm_2023.389.issue-1\/nejmoa2214552\/20230703\/images\/img_xlarge\/nejmoa2214552_t1.jpeg\" alt=\"\"\/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/www.nejm.org\/na101\/home\/literatum\/publisher\/mms\/journals\/content\/nejm\/2023\/nejm_2023.389.issue-1\/nejmoa2214552\/20230703\/images\/img_xlarge\/nejmoa2214552_f1.jpeg\" alt=\"\"\/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/www.nejm.org\/na101\/home\/literatum\/publisher\/mms\/journals\/content\/nejm\/2023\/nejm_2023.389.issue-1\/nejmoa2214552\/20230703\/images\/img_xlarge\/nejmoa2214552_t2.jpeg\" alt=\"\"\/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/www.nejm.org\/na101\/home\/literatum\/publisher\/mms\/journals\/content\/nejm\/2023\/nejm_2023.389.issue-1\/nejmoa2214552\/20230703\/images\/img_xlarge\/nejmoa2214552_f2.jpeg\" alt=\"\"\/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/www.nejm.org\/na101\/home\/literatum\/publisher\/mms\/journals\/content\/nejm\/2023\/nejm_2023.389.issue-1\/nejmoa2214552\/20230703\/images\/img_xlarge\/nejmoa2214552_t3.jpeg\" alt=\"\"\/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">CONCLUSIONS<\/h2>\n\n\n\n<p>In patients with coma who were resuscitated after out-of-hospital cardiac arrest, targeted mild hypercapnia did not lead to better neurologic outcomes at 6 months than targeted normocapnia. (Funded by the National Health and Medical Research Council of Australia and others; TAME ClinicalTrials.gov number,&nbsp;<a href=\"http:\/\/clinicaltrials.gov\/show\/NCT03114033\" target=\"_blank\" rel=\"noreferrer noopener\">NCT03114033. opens in new tab<\/a>.)<\/p>\n","protected":false},"excerpt":{"rendered":"<p>ORIGINAL ARTICLE Mild Hypercapnia or Normocapnia after  [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24283"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=24283"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24283\/revisions"}],"predecessor-version":[{"id":24452,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24283\/revisions\/24452"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=24283"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=24283"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=24283"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}