RT Journal Article
SR Electronic
T1 Late permissive hypercapnia and respiratory stability among very preterm infants: a pilot randomised trial
JF Archives of Disease in Childhood - Fetal and Neonatal Edition
JO Arch Dis Child Fetal Neonatal Ed
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP fetalneonatal-2022-325166
DO 10.1136/archdischild-2022-325166
A1 Colm P Travers
A1 Waldemar A Carlo
A1 Arie Nakhmani
A1 Deborah Laney
A1 Rouba A Chahine
A1 Immaculada Aban
A1 Namasivayam Ambalavanan
YR 2023
UL http://fn.bmj.com/content/early/2023/03/12/archdischild-2022-325166.abstract
AB Objective Determine if targeting higher transcutaneous carbon dioxide improves respiratory stability among very preterm infants on ventilatory support.Design Single-centre pilot randomised clinical trial.Setting The University of Alabama at Birmingham.Patients Very preterm infants on ventilatory support after postnatal day 7.Interventions Infants were randomised to two different transcutaneous carbon dioxide levels targeting 5 mm Hg (0.67 kPa) changes with four sessions each lasting 24 hours for 96 hours: baseline-increase-baseline-increase or baseline-decrease-baseline-decrease.Main outcome measures We collected cardiorespiratory data evaluating episodes of intermittent hypoxaemia (oxygen saturations (SpO2)<85% for ≥10 s), bradycardia (<100 bpm for ≥10 s), and cerebral and abdominal hypoxaemia on near-infrared spectroscopy.Results We enrolled 25 infants with a gestational age of 24 w 6 d±11 d (mean±SD) and birth weight 645±142 g on postnatal day 14±3. Continuous transcutaneous carbon dioxide values (56.8±6.9 in the higher group vs 54.5±7.8 in the lower group; p=0.36) did not differ significantly between groups during the intervention days. There were no differences in intermittent hypoxaemia (126±64 vs 105±61 per 24 hours; p=0.30) or bradycardia (11±16 vs 15±23 per hour; p=0.89) episodes between groups. The proportion of time with SpO2<85%, SpO2<80%, cerebral hypoxaemia or abdominal hypoxaemia did not differ (all p>0.05). There was moderate negative correlation between mean transcutaneous carbon dioxide and bradycardia episodes (r=−0.56; p<0.001).Conclusion Targeting 5 mm Hg (0.67 kPa) changes in transcutaneous carbon dioxide did not improve respiratory stability among very preterm infants on ventilatory support but the intended carbon dioxide separation was difficult to achieve and maintain.Trial registration number NCT03333161.Data are available upon reasonable request.