{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T23:57:46Z","timestamp":1783727866999,"version":"3.55.0"},"reference-count":8,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Esophagectomy in the prone position can induce acute respiratory acidosis. While it is known that metabolic acidosis can significantly elevate serum potassium, the effect of respiratory acidosis is conventionally considered to cause minimal or no elevation. However, clinical practice in this surgical setting sometimes reveals a greater-than-expected degree of hyperkalemia. The objective of this study is to investigate the association between this acute respiratory acidosis and hyperkalemia, and to explore its clinical implications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This is a retrospective, two-center observational study of adult patients who underwent thoracoscopic esophagectomy in the prone position at two major Japanese institutions between January 2022 and December 2024. The primary outcome is the mean difference in serum potassium levels between the supine (baseline) and prone-position phases, analyzed as a paired-design within each patient. Key secondary outcomes include: 1) a multivariable analysis to identify factors associated with the magnitude of potassium increase; 2) a sensitivity analysis of the primary outcome after excluding cases with significant metabolic acidosis (e.g., base excess\u2009&lt;\u2009\u22125 mmol\/L); and 3) correlation analyses between the change in potassium and various physiological parameters, including PaCO\u2082 and markers of metabolic stress. Analyses will include the paired t-test, correlation analyses, and multivariable regression models.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0337018","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T18:39:24Z","timestamp":1769539164000},"page":"e0337018","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association between acute respiratory acidosis and hyperkalemia during esophageal cancer surgery in the prone position: A multicenter retrospective observational study protocol"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6616-2884","authenticated-orcid":true,"given":"Sakura","family":"Okamoto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tokiko","family":"Tochii","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jyunya","family":"Nakada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideaki","family":"Note","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"issue":"5","key":"pone.0337018.ref001","doi-asserted-by":"crossref","DOI":"10.1093\/bjsopen\/zrab068","article-title":"Action-related eye measures to assess surgical expertise","volume":"5","author":"B Zheng","year":"2021","journal-title":"BJS Open"},{"issue":"6","key":"pone.0337018.ref002","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.2215\/CJN.08580813","article-title":"Regulation of potassium homeostasis","volume":"10","author":"BF Palmer","year":"2015","journal-title":"Clin J Am Soc Nephrol"},{"issue":"3","key":"pone.0337018.ref003","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1016\/0002-9343(81)90182-0","article-title":"Changes in plasma potassium concentration during acute acid-base disturbances","volume":"71","author":"HJ Adrogu\u00e9","year":"1981","journal-title":"Am J Med"},{"issue":"2","key":"pone.0337018.ref004","doi-asserted-by":"crossref","DOI":"10.34172\/npj.2024.11684","article-title":"Severe respiratory acidosis contributing to refractory hyperkalemia: a case series of COVID-19 patients with renal failure","volume":"13","author":"N Pathak","year":"2024","journal-title":"J Nephropharmacol"},{"issue":"2","key":"pone.0337018.ref005","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1007\/s10557-018-6783-0","article-title":"Association of abnormal serum potassium levels with arrhythmias and cardiovascular mortality: a systematic review and meta-analysis of observational studies","volume":"32","author":"LK Hoppe","year":"2018","journal-title":"Cardiovasc Drugs Ther"},{"issue":"7","key":"pone.0337018.ref006","doi-asserted-by":"crossref","DOI":"10.1111\/nep.70100","article-title":"Baseline potassium levels and their association with electrocardiograph abnormalities in hyperkalaemia","volume":"30","author":"T Nakayama","year":"2025","journal-title":"Nephrology (Carlton)"},{"issue":"3","key":"pone.0337018.ref007","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1213\/ANE.0000000000004544","article-title":"A prospective, randomized trial comparing respiratory status during anesthesia for airway stenting: spontaneous respiration versus controlled ventilation with muscle relaxants","volume":"131","author":"S Okamoto","year":"2020","journal-title":"Anesth Analg"},{"issue":"1","key":"pone.0337018.ref008","doi-asserted-by":"crossref","first-page":"10391","DOI":"10.1038\/s41598-021-89913-x","article-title":"End-tidal to arterial carbon dioxide gradient is associated with increased mortality in patients with traumatic brain injury: a retrospective observational study","volume":"11","author":"P Doppmann","year":"2021","journal-title":"Sci Rep"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0337018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T18:39:26Z","timestamp":1769539166000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0337018"}},"subtitle":[],"editor":[{"given":"Paolo","family":"Aurello","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1,27]]},"references-count":8,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,27]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0337018","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,27]]}}}