Hypercapnia during the first 3 days of life is associated with severe intraventricular hemorrhage in very low birth weight infants

Kaiser, Jeffrey R.; Gauss, C. Heath; Pont, Molly; Williams, David

doi:10.1038/sj.jp.7211492

Cited by 189 publications

(106 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…37,38 Conversely, if the pressure control level is not increased due to worsening lung mechanics and consequent hypoventilation, then the patient can become profoundly hypercarbic, which may increase the risk of developing intraventricular hemorrhage. 39,40 Prolonged ventilation at low inspiratory pressure and low lung volume can also cause atelectrauma and VILI. 41 Recently improved volume monitoring capabilities, lung mechanics measurements, and system alarms can better guide clinicians in ventilator adjustments.…”

Section: Pressure Control Ventilation Versus Volume-targeted Ventilationmentioning

confidence: 99%

Mechanical Ventilation of the Premature Neonate

Brown

DiBlasi

2011

Respir Care

View full text Add to dashboard Cite

Section: Pressure Control Ventilation Versus Volume-targeted Ventilationmentioning

confidence: 99%

Mechanical Ventilation of the Premature Neonate

Brown

DiBlasi

2011

Respir Care

View full text Add to dashboard Cite

“…However, researchers question whether these higher P CO 2 levels are safe for other organs, especially the brain. 7 The benefits of reducing instrumental dead space or mitigating its effects are well-recognized and discussed in the literature. 8,9 Multiple approaches to reduce instrumental dead space and/or its effects on patients have been proposed; 3,[8][9][10][11][12][13][14][15] these suggestions even include using lung assist with extracorporeal CO 2 removal.…”

Section: Introductionmentioning

confidence: 99%

Reduction of Endotracheal Tube Connector Dead Space Improves Ventilation: A Bench Test on a Model Lung Simulating an Extremely Low Birth Weight Neonate

Ivanov

2015

Respir Care

View full text Add to dashboard Cite

BACKGROUND: The reduction of instrumental dead space is a recognized approach to preventing ventilation-induced lung injury in premature infants. However, there are no published data regarding the effectiveness of instrumental dead-space reduction in endotracheal tube (ETT) connectors. We tested the impact of the Y-piece/ETT connector pairs with reduced instrumental dead space on CO 2 elimination in a model of the premature neonate lung. METHODS: The standard ETT connector was compared with a low-dead-space ETT connector and with a standard connector equipped with an insert. We compared the setups by measuring the CO 2 elimination rate in an artificial lung ventilated via the connectors. The lung was connected to a ventilator via a standard circuit, a 2.5-mm ETT, and one of the connectors under investigation. The ventilator was run in volume-controlled continuous mandatory ventilation mode. RESULTS: The low-dead-space ETT connector/Y-piece and insert-equipped standard connector/Y-piece pairs had instrumental dead space reduced by 36 and 67%, respectively. With set tidal volumes (V T ) of 2.5, 5, and 10 mL, in comparison with the standard ETT connector, the low-dead-space connector reduced CO 2 elimination time by 4.5% (P < .05), 4.4% (P < .01), and 7.1% (not significant), respectively. The insert-equipped standard connector reduced CO 2 elimination time by 13.5, 25.1, and 16.1% (all P < .01). The low-dead-space connector increased inspiratory resistance by 17.8% (P < .01), 9.6% (P < .05), and 5.0% (not significant); the insert-equipped standard connector increased inspiratory resistance by 9.1, 8.4, and 5.9% (all not significant). The low-dead-space connector decreased expiratory resistance by 6.8% (P < .01) and 1.8% (not significant) and increased it by 1.4% (not significant); the insert-equipped standard connector decreased expiratory resistance by 1.5 and 1% and increased it by 1% (all not significant). The low-dead-space connector increased work of breathing by 4.7% (P < .01), 3.8% (P < .01), and 2.5% (not significant); the insert-equipped standard connector increased it by 0.8% (not significant), 2.5% (P < .01), and 2.8% (P < . IntroductionVentilator-induced lung injury is considered an important causative factor in the pathophysiology of bronchopulmonary dysplasia (BPD) in premature infants. 1 Limiting ventilator-associated lung overdistention/damage is a well-recognized approach for the prevention of BPD, but Dr Ivanov is affiliated with the Section

show abstract

“…On the one hand, there are substantiated concerns about the association between hypercapnia and IVH in preterm infants, 54 especially during the first days of life. 55 Moreover, hypercapnia can go unnoticed if respiratory drive is poor, and transcutaneous CO 2 monitoring is not popular because the electrodes can cause heat damage on extremely immature skin. 56 On the other hand, mild hypercapnia has long been regarded as safe in premature infants ,1000 g, and permissive hypercapnia can be used as a way of reducing eMV and improving pulmonary outcomes.…”

mentioning

confidence: 99%

Avoiding Endotracheal Ventilation to Prevent Bronchopulmonary Dysplasia: A Meta-analysis

2013

View full text Add to dashboard Cite

Avoiding Endotracheal Ventilation to Prevent Bronchopulmonary Dysplasia: A Meta-analysis abstract BACKGROUND AND OBJECTIVE: Mechanical ventilation via an endotra-cheal tube is a risk factor for bronchopulmonary dysplasia (BPD), one of the most common morbidities of very preterm infants. Our objective was to investigate the effect that strategies to avoid endotracheal mechanical ventilation (eMV) have on the incidence of BPD in preterm infants ,30 weeks' gestational age (GA). METHODS: In February 2013, we searched the databases Medline, Embase, and the Cochrane Central Register of Controlled Trials. Study selection criteria included randomized controlled trials published in peer-reviewed journals since the year 2000 that compared preterm infants ,30 weeks' GA treated by using a strategy aimed at avoiding eMV with a control group in which mechanical ventilation via an endotracheal tube was performed at an earlier stage. Data were extracted and analyzed by using the standard methods of the Cochrane Neonatal Review Group. The authors independently assessed study eligibility and risk of bias, extracted data and calculated odds ratios and 95% confidence intervals, employing RevMan version 5.1.6. RESULTS: We identified 7 trials that included a total of 3289 infants. The combined odds ratio (95% confidence interval) of death or BPD was 0.83 (0.71-0.96). The number needed to treat was 35. The study results were remarkably homogeneous. Avoiding eMV had no influence on the incidence of severe intraventricular hemorrhage.

show abstract

Hypercapnia during the first 3 days of life is associated with severe intraventricular hemorrhage in very low birth weight infants

Cited by 189 publications

References 26 publications

Mechanical Ventilation of the Premature Neonate

Mechanical Ventilation of the Premature Neonate

Reduction of Endotracheal Tube Connector Dead Space Improves Ventilation: A Bench Test on a Model Lung Simulating an Extremely Low Birth Weight Neonate

Avoiding Endotracheal Ventilation to Prevent Bronchopulmonary Dysplasia: A Meta-analysis

Contact Info

Product

Resources

About