Permissive hypercapnia for the prevention of morbidity and mortality in mechanically ventilated newborn infants

Abstract

Permissive hypercapnia for the prevention of morbidity and mortality in mechanically ventilated newborn infants.

Efficacy and safety of permissive hypercapnia in preterm infants: A systematic review

“…This systematic review found that permissive hypercapnia did not have significant adverse neurological effects (severe IVH and NDI), consistent with the findings of previous systematic reviews 29,31 . The increased risk of IVH due to permissive hypercapnia was also concerning in this review.…”

“…This systematic review found that permissive hypercapnia did not have significant adverse neurological effects (severe IVH and NDI), consistent with the findings of previous systematic reviews. 29,31 The increased risk of IVH due to permissive hypercapnia was also concerning in this review. High PaCO 2 and low pH dilate cerebral blood vessels, increase cerebral blood flow, and cause fluctuations in cerebral blood flow, which may predispose infants to IVH.…”

“…16 Unlike the previous systematic reviews that used BPD diagnosed at 28 days of age, this systematic review defined BPD as the use of oxygen or respiratory pressure support (e.g., CPAP, HFNC at a rate of >2 L/min) at 36 weeks of postmenstrual age. [29][30][31] Although defining BPD has been a controversial issue in recent years, the definitions or diagnoses near term or later (from 36 to 40 weeks postmenstrual age or to 1 year of age) are considered better than those at 28 days or a month after birth because the former definitions predict long-term adverse consequences better than the latter. 32 The last systematic review on this topic ( weeks, we found that hypercapnia did not reduce BPD.…”

Efficacy and safety of permissive hypercapnia in preterm infants: A systematic review

“…This systematic review found that permissive hypercapnia did not have significant adverse neurological effects (severe IVH and NDI), consistent with the findings of previous systematic reviews 29,31 . The increased risk of IVH due to permissive hypercapnia was also concerning in this review.…”

“…This systematic review found that permissive hypercapnia did not have significant adverse neurological effects (severe IVH and NDI), consistent with the findings of previous systematic reviews. 29,31 The increased risk of IVH due to permissive hypercapnia was also concerning in this review. High PaCO 2 and low pH dilate cerebral blood vessels, increase cerebral blood flow, and cause fluctuations in cerebral blood flow, which may predispose infants to IVH.…”

“…16 Unlike the previous systematic reviews that used BPD diagnosed at 28 days of age, this systematic review defined BPD as the use of oxygen or respiratory pressure support (e.g., CPAP, HFNC at a rate of >2 L/min) at 36 weeks of postmenstrual age. [29][30][31] Although defining BPD has been a controversial issue in recent years, the definitions or diagnoses near term or later (from 36 to 40 weeks postmenstrual age or to 1 year of age) are considered better than those at 28 days or a month after birth because the former definitions predict long-term adverse consequences better than the latter. 32 The last systematic review on this topic ( weeks, we found that hypercapnia did not reduce BPD.…”

Permissive Hypercapnia in the Management of Congenital Diaphragmatic Hernia: Our Institutional Experience

“…A recent Cochrane review, although not limited to CDH management, indicated that there is not enough evidence to support the use of permissive hypercapnia over normocapnia as a superior ventilatory management strategy. 13 However, our positive results are similar to those at other institutions that have adopted permissive hypercapnia for the management of CDH, 6,7,11,14–16 A strong trend toward lower overall morbidity was also identified but was not statistically significant in our study. Overall, our 2 groups were statistically similar, so theoretically there should be no difference in outcomes attributable to demographic differences between the 2 groups.…”

Determining the Ventilatory Volumes Required to Ventilate Low Birth Weight Infants with Respiratory Distress Syndrome

“…In the first of those trials [16], the difference in PaCO 2 levels did not become significant until 12 h after randomisation. In a recent systematic review and meta-analysis of those two trials Woodgate and Davies [14] state that 'if permissive hypercapnia/minimal ventilation techniques are to reduce pulmonary morbidity and be neuroprotective, the benefits of these strategies may only be realised if they are instituted immediately following birth' -the setting of appropriate VTs and MTs may help greatly in achieving these goals.…”

Efficacy and safety of permissive hypercapnia in preterm infants: A systematic review

“…This systematic review found that permissive hypercapnia did not have significant adverse neurological effects (severe IVH and NDI), consistent with the findings of previous systematic reviews 29,31 . The increased risk of IVH due to permissive hypercapnia was also concerning in this review.…”

“…This systematic review found that permissive hypercapnia did not have significant adverse neurological effects (severe IVH and NDI), consistent with the findings of previous systematic reviews. 29,31 The increased risk of IVH due to permissive hypercapnia was also concerning in this review. High PaCO 2 and low pH dilate cerebral blood vessels, increase cerebral blood flow, and cause fluctuations in cerebral blood flow, which may predispose infants to IVH.…”

“…16 Unlike the previous systematic reviews that used BPD diagnosed at 28 days of age, this systematic review defined BPD as the use of oxygen or respiratory pressure support (e.g., CPAP, HFNC at a rate of >2 L/min) at 36 weeks of postmenstrual age. [29][30][31] Although defining BPD has been a controversial issue in recent years, the definitions or diagnoses near term or later (from 36 to 40 weeks postmenstrual age or to 1 year of age) are considered better than those at 28 days or a month after birth because the former definitions predict long-term adverse consequences better than the latter. 32 The last systematic review on this topic ( weeks, we found that hypercapnia did not reduce BPD.…”

Permissive Hypercapnia in the Management of Congenital Diaphragmatic Hernia: Our Institutional Experience

“…A recent Cochrane review, although not limited to CDH management, indicated that there is not enough evidence to support the use of permissive hypercapnia over normocapnia as a superior ventilatory management strategy. 13 However, our positive results are similar to those at other institutions that have adopted permissive hypercapnia for the management of CDH, 6,7,11,14–16 A strong trend toward lower overall morbidity was also identified but was not statistically significant in our study. Overall, our 2 groups were statistically similar, so theoretically there should be no difference in outcomes attributable to demographic differences between the 2 groups.…”

Determining the Ventilatory Volumes Required to Ventilate Low Birth Weight Infants with Respiratory Distress Syndrome

“…In the first of those trials [16], the difference in PaCO 2 levels did not become significant until 12 h after randomisation. In a recent systematic review and meta-analysis of those two trials Woodgate and Davies [14] state that 'if permissive hypercapnia/minimal ventilation techniques are to reduce pulmonary morbidity and be neuroprotective, the benefits of these strategies may only be realised if they are instituted immediately following birth' -the setting of appropriate VTs and MTs may help greatly in achieving these goals.…”

Efficacy and safety of permissive hypercapnia in preterm infants: A systematic review

“…This systematic review found that permissive hypercapnia did not have significant adverse neurological effects (severe IVH and NDI), consistent with the findings of previous systematic reviews 29,31 . The increased risk of IVH due to permissive hypercapnia was also concerning in this review.…”

“…This systematic review found that permissive hypercapnia did not have significant adverse neurological effects (severe IVH and NDI), consistent with the findings of previous systematic reviews. 29,31 The increased risk of IVH due to permissive hypercapnia was also concerning in this review. High PaCO 2 and low pH dilate cerebral blood vessels, increase cerebral blood flow, and cause fluctuations in cerebral blood flow, which may predispose infants to IVH.…”

“…16 Unlike the previous systematic reviews that used BPD diagnosed at 28 days of age, this systematic review defined BPD as the use of oxygen or respiratory pressure support (e.g., CPAP, HFNC at a rate of >2 L/min) at 36 weeks of postmenstrual age. [29][30][31] Although defining BPD has been a controversial issue in recent years, the definitions or diagnoses near term or later (from 36 to 40 weeks postmenstrual age or to 1 year of age) are considered better than those at 28 days or a month after birth because the former definitions predict long-term adverse consequences better than the latter. 32 The last systematic review on this topic ( weeks, we found that hypercapnia did not reduce BPD.…”

Permissive Hypercapnia in the Management of Congenital Diaphragmatic Hernia: Our Institutional Experience

“…A recent Cochrane review, although not limited to CDH management, indicated that there is not enough evidence to support the use of permissive hypercapnia over normocapnia as a superior ventilatory management strategy. 13 However, our positive results are similar to those at other institutions that have adopted permissive hypercapnia for the management of CDH, 6,7,11,14–16 A strong trend toward lower overall morbidity was also identified but was not statistically significant in our study. Overall, our 2 groups were statistically similar, so theoretically there should be no difference in outcomes attributable to demographic differences between the 2 groups.…”

Determining the Ventilatory Volumes Required to Ventilate Low Birth Weight Infants with Respiratory Distress Syndrome

“…In the first of those trials [16], the difference in PaCO 2 levels did not become significant until 12 h after randomisation. In a recent systematic review and meta-analysis of those two trials Woodgate and Davies [14] state that 'if permissive hypercapnia/minimal ventilation techniques are to reduce pulmonary morbidity and be neuroprotective, the benefits of these strategies may only be realised if they are instituted immediately following birth' -the setting of appropriate VTs and MTs may help greatly in achieving these goals.…”