Carbon dioxide levels in neonates: what are safe parameters?

Wong, Sie Kei; Chim, M; Allen, John A.; Butler, Aileen; Tyrrell, John; Hurley, Tim; McGovern, Matthew; Omer, Murwan; Lagan, Niamh; Meehan, Judith; Cummins, Eoin P.; Molloy, Eleanor J.

doi:10.1038/s41390-021-01473-y

Cited by 21 publications

(16 citation statements)

References 61 publications

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“…The concept of facilitating earlier extubation by tolerating mild hypercapnia is long-standing [155]. Recent systematic review suggests the safest range for CO 2 is around 5–7 kPa, with hypocapnia in preterm infants being associated with increased risk of periventricular leukomalacia and severe hypercapnia linked with IVH, NEC, BPD, and ROP [156]. Permissive hypercapnia will potentially allow reduced tidal volumes and facilitate extubation, though there is no convincing evidence that it reduces BPD.…”

Section: Introductionmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

et al. 2023

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Respiratory distress syndrome (RDS) care pathways evolve slowly as new evidence emerges. We report the sixth version of “European Guidelines for the Management of RDS” by a panel of experienced European neonatologists and an expert perinatal obstetrician based on available literature up to end of 2022. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, appropriate maternal transfer to a perinatal centre, and appropriate and timely use of antenatal steroids. Evidence-based lung-protective management includes initiation of non-invasive respiratory support from birth, judicious use of oxygen, early surfactant administration, caffeine therapy, and avoidance of intubation and mechanical ventilation where possible. Methods of ongoing non-invasive respiratory support have been further refined and may help reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation by targeted use of postnatal corticosteroids remains essential. The general care of infants with RDS is also reviewed, including emphasis on appropriate cardiovascular support and judicious use of antibiotics as being important determinants of best outcome. We would like to dedicate this guideline to the memory of Professor Henry Halliday who died on November 12<sup>,</sup> 2022.These updated guidelines contain evidence from recent Cochrane reviews and medical literature since 2019. Strength of evidence supporting recommendations has been evaluated using the GRADE system. There are changes to some of the previous recommendations as well as some changes to the strength of evidence supporting recommendations that have not changed. This guideline has been endorsed by the European Society for Paediatric Research (ESPR) and the Union of European Neonatal and Perinatal Societies (UENPS).

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Section: Introductionmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

et al. 2023

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“…There is currently no consensus on optimal pCO 2 levels and the effectiveness of permissive hypercapnia in newborns ( 34 ). The UK National Institute of Health and Clinical Excellence (NICE) guidelines support the use of thoracoscopy for the repair of CDH in neonates, but do not address safety concerns related to hypercapnia and acidosis.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for anesthesia-associated postoperative capillary leakage after thoracoscopic surgery in neonates: A single-center observational study

Liu

Wang²,

Zhang³

et al. 2023

Front. Pediatr.

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BackgroundThoracoscopy is considered the surgical method of choice for addressing a wide range of conditions in neonates. However, there is a lack of experience in anesthesia management for this procedure. On reviewing the newborns who had undergone thoracoscopic surgery at our medical center, some had developed edema after surgery. After excluding other etiologies, these neonates were diagnosed with capillary leakage secondary to thoracoscopy.AimsThis study aimed to identify the potential risk factors for capillary leakage secondary to thoracoscopy in neonates and to provide reference information for optimal anesthesia management.MethodsThis single-center, retrospective, observational study examined neonates who had undergone thoracoscopic surgery between January 1, 2018, and September 31, 2021. Their electronic medical records were analyzed for demographic and clinical characteristics associated with anesthesia, and postoperative capillary leakage occurring within 24 and 48 h of surgery was assessed based on medical records.ResultsA total of 56 neonates that underwent thoracoscopic surgery were included in this study. Postoperative capillary leakage within 24 h was diagnosed in 14 neonates (25%). The partial pressure of carbon dioxide was an independent factor influencing the occurrence of postoperative edema within 24 h (P = 0.021). Overall, 21 cases (37.5%) were diagnosed as postoperative capillary leakage within 48 h, and age was an independent factor influencing the occurrence of postoperative edema within 48 h (P = 0.027).ConclusionsAccording to our findings, we concluded that preventing the elevation of the partial pressure of carbon dioxide may reduce the occurrence of secondary capillary leakage within 24 h after thoracoscopic surgery, and that older newborns are less likely to have secondary capillary leakage within 48 h after thoracoscopic surgery. Our findings provide evidence that directly informs anesthesia management for thoracoscopic surgery in neonates.Clinical trial registrationThe study was registered in the Chinese Clinical Trial Registry (ChiCTR2100054117).

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“…However, the safe limits of P.H. in the early days of life, when the risk of intraventricular hemorrhage (IVH) is the highest, and later in the chronic phase of BPD are not yet clear [50].…”

Section: Permissive Hypercapniamentioning

confidence: 99%

Weaning and extubation from neonatal mechanical ventilation: an evidenced-based review

et al. 2022

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Mechanical ventilation is a lifesaving treatment used to treat critical neonatal patients. It facilitates gas exchange, oxygenation, and CO2 removal. Despite advances in non-invasive ventilatory support methods in neonates, invasive ventilation (i.e., ventilation via an endotracheal tube) is still a standard treatment in NICUs. This ventilation approach may cause injury despite its advantages, especially in preterm neonates. Therefore, it is recommended that neonatologists consider weaning neonates from invasive mechanical ventilation as soon as possible. This review examines the steps required for the neonate's appropriate weaning and safe extubation from mechanical ventilation.

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Carbon dioxide levels in neonates: what are safe parameters?

Cited by 21 publications

References 61 publications

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

Risk factors for anesthesia-associated postoperative capillary leakage after thoracoscopic surgery in neonates: A single-center observational study

Weaning and extubation from neonatal mechanical ventilation: an evidenced-based review

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