{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T11:37:36Z","timestamp":1793619456198,"version":"4.5.0"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2023,3,10]],"date-time":"2023-03-10T00:00:00Z","timestamp":1678406400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Japan Society for the Promotion of Science KAKENHI program","award":["rant number: 20K09242"],"award-info":[{"award-number":["rant number: 20K09242"]}]},{"name":"the 2019 Kyoto University ISHIZUE Research Development Program"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Data on the effects of intraoperative end-tidal carbon dioxide (EtCO\n                      <jats:sub>2<\/jats:sub>\n                      ) levels on postoperative organ dysfunction are limited. Thus, this study was designed to investigate the relationship between the intraoperative EtCO\n                      <jats:sub>2<\/jats:sub>\n                      level and postoperative organ dysfunction in patients who underwent major abdominal surgery under general anesthesia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a cohort study involving patients who underwent major abdominal surgery under general anesthesia at Kyoto University Hospital. We classified those with a mean EtCO\n                      <jats:sub>2<\/jats:sub>\n                      of less than 35 mmHg as low EtCO\n                      <jats:sub>2<\/jats:sub>\n                      . The time effect was determined as the minutes when the EtCO\n                      <jats:sub>2<\/jats:sub>\n                      value 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 4,171 patients, 1,195 (28%) had low EtCO\n                      <jats:sub>2<\/jats:sub>\n                      , and 1,428 (34%) had postoperative organ dysfunction. An association was found between low EtCO\n                      <jats:sub>2<\/jats:sub>\n                      and increased postoperative organ dysfunction (adjusted risk ratio, 1.11; 95% confidence interval [CI], 1.03\u20131.20;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.006). Additionally, long-term exposure to EtCO\n                      <jats:sub>2<\/jats:sub>\n                      values of less than 35 mmHg (\u2265224 min) was associated with postoperative organ dysfunction (adjusted risk ratio, 1.18; 95% CI, 1.06\u20131.32;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.003) and low EtCO\n                      <jats:sub>2<\/jats:sub>\n                      severity (area under the threshold) (adjusted risk ratio, 1.13; 95% CI, 1.02\u20131.26;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.018).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Intraoperative low EtCO\n                      <jats:sub>2<\/jats:sub>\n                      of below 35 mmHg was associated with increased postoperative organ dysfunction.\n     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