Randomised study comparing extent of hypocarbia in preterm infants during conventional and patient triggered ventilation. Issue 1 (1st January 2001)

• Record Type: Journal Article
• Authors: Luyt, K; Wright, D; Baumer, J H
• Is Part Of: Archives of disease in childhood. Volume 84:Issue 1(2001)
• Page Start: F14
• Page End: F17
• Publication Date: 2001-01-01
• Subjects: patient triggered ventilation -- intermittent positive pressure ventilation -- hypocarbia; Infants -- Diseases -- Periodicals; Newborn infants -- Diseases -- Periodicals; Fetus -- Diseases -- Periodicals; 618.920105
• DOI: 10.1136/fn.84.1.F14
• Languages: English
• ISSNs: 1359-2998

Abstract

Abstract : AIM: To determine whether patient triggered ventilation (PTV) leads to greater exposure to significant hypocarbia than conventional ventilation (CMV) in premature infants during the first 72 hours of life. METHODS: Infants of 32 weeks gestation or less were included. Randomisation yielded 74 infants on PTV and 68 infants on CMV. Arterial Paco 2 measurements were taken four hourly for the first 72 hours of life. RESULTS: The mean Paco 2 levels on days 1, 2, and 3 were not significantly different between the two groups. The proportion of infants with Paco 2 levels of 3.33 kPa or less did not differ between PTV and CMV infants. Mean percentages of infants with this level of hypocarbia at any time were 31.4%, 18.9%, 8.8% on days 1, 2, and 3 respectively. Cumulative hypocarbia, below a 3.33 kPa threshold, was 0.0084 kPa.h (PTV) versus 0.0263 kPa.h (CMV) per hour ventilated during the first 24 hours (p = 0.259). Risk factors associated with hypocarbia on day 1 were peak inspiratory pressure below 14 cm H2 O (odds ratio 4.79) as well as Fio 2 below 0.30 (odds ratio 3.42). CONCLUSION: Exposure to hypocarbia (Paco 2 3.33 kPa or below) was not significantly different between PTV and CMV infants during the first 72 hours of life. Hypocarbia was common in both groups on day 1 and to a lesser extent on day 2. Infants with the least requirements for ventilatory support were at highest risk of hypocarbia on day 1 of life. Preterm infants with mild hyaline membrane disease require a more aggressive approach to weaning on both modes of ventilation, followed by extubation to limit the risk of hypocarbia.