Safety and effectiveness of permissive hypercapnia in the preterm infant.
OBJECTIVE
Bronchopulmonary dysplasia continues to be an important cause of morbidity in premature infants who require mechanical ventilation. Management strategies have historically focused on normalizing blood gases but new research suggests that a higher PCO2 level may be well tolerated in premature infants. There are physiologic rationale and recent experimental data to support the potential benefits of permissive hypercapnia.


RESULTS
Higher PCO2 levels may allow a reduction in ventilatory support which reduces the risk of lung injury in intubated patients. Targeting PCO2 levels above 45 mmHg has been tested in randomized controlled trials. These trials report that neonates managed with permissive hypercapnia have a shorter duration of mechanical ventilation and reduced severity of bronchopulmonary dysplasia without an increase in adverse events.


CONCLUSIONS
Permissive hypercapnia appears as a safe and effective management strategy to decrease morbidity from bronchopulmonary dysplasia in premature infants. Although the preliminary results are promising, further research is needed to determine whether this strategy improves pulmonary outcomes without adverse effects.
Miller
J Davin
JD
University of Alabama at Birmingham, AL 35233-7335, USA.
Carlo
Waldemar A
WA
D000818:Animals; D001997:Bronchopulmonary Dysplasia / Q000517:prevention & control; D002245:Carbon Dioxide / Q000097:blood*; D006801:Humans; D006935:Hypercapnia; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000628:therapy*; D008171:Lung Diseases / Q000628:therapy; D012121:Respiration, Artificial / Q000379:methods*
D002245:Carbon Dioxide