Randomized trial of permissive hypercapnia in preterm infants
Randomized trial of permissive hypercapnia in preterm infants
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DOI：
10.1542/peds.104.5.1082
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发表时间：
1999-11-01
期刊：
影响因子：
8
通讯作者：
Carlo, WA
中科院分区：
文献类型：
--
作者：
Mariani, G;Cifuentes, J;Carlo, WA
Objective.确定允许性高碳酸血症（PHC）的缓解策略是否可缩短出生时体重601 - 1250 g经表面活性剂治疗的新生儿的辅助通气时间。49名接受辅助通气的经表面活性剂治疗的早产儿（出生体重：854 ± 163 g;胎龄：26 ± 1.4周）在出生后24小时内随机分为PHC组（PaCO 2：45-55 mm Hg）或正常碳酸血症组（NC; PaCO 2：35-45 mm Hg）。主要结果指标是辅助通气的总天数。两组均采用统一的拔管和再插管标准。拔管前均给予氨茶碱治疗。辅助通气的总天数表示为中位值（第25 - 75个月），PHC组为2.5（1.5-11.5），NC组为9.5（2.0-22.5）（Mann-Whitney U检验）。PHC组在随机化后前96小时内接受辅助通气的患者数量较低（对数秩检验）。在此期间，PHC组的机械通气患者的PaCO 2高于NC组，而吸气峰压、平均气道压和呼吸机频率低于NC组。拔管后24小时内需要重新插管的患者百分比（PHC 17% vs NC 28%）和出生后28天需要补充氧气的患者百分比（PHC 43% vs NC 64%）以及总的氧气补充天数（PHC 15 [4-53] vs NC 32 [17-50]）在两组之间没有差异。在死亡率、漏气、脑室内出血、脑室周围白质软化、早产儿视网膜病变或动脉导管未闭方面没有差异。在接受辅助通气的早产儿中，PHC的治疗策略是可行的，似乎是安全的，并且可以减少辅助通气的持续时间。
Objective. To determine whether a ventilatory strategy of permissive hypercapnia (PHC) reduces the duration of assisted ventilation in surfactant-treated neonates weighing 601 to 1250 g at birth.Design. Forty-nine surfactant-treated preterm infants (birth weight: 854 +/- 163 g; gestational age: 26 +/- 1.4 weeks) receiving assisted ventilation were randomized during the first 24 hours of age to a PHC group (PaCO2 : 45-55 mm Hg) or to a normocapnia group (NC; PaCO2 : 35-45 mm Hg). The primary outcome measure was the total number of days on assisted ventilation. Uniform extubation and reintubation criteria were used for both groups. All patients received aminophylline before extubation.Results. The total number of days on assisted ventilation expressed as median (25th-75th percentiles) was 2.5 (1.5-11.5) in the PHC group and 9.5 (2.0-22.5) in the NC group (Mann-Whitney U test). The number of patients on assisted ventilation throughout the first 96 hours after randomization was lower in the PHC group (log rank test). During that period, the ventilated patients in the PHC group had a higher PaCO2 and lower peak inspiratory pressure, mean airway pressure, and ventilator rate than did those in the NC group. The percentage of patients requiring reintubation within 24 hours postextubation (PHC 17% vs NC 28%) and supplemental oxygen at 28 days of life (PHC 43% vs NC 64%) and the total days of oxygen supplementation (PHC 15 [4-53] vs NC 32 [17-50]) did not differ between the groups. There were no differences in mortality, air leaks, intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity, or patent ductus arteriosus.Conclusion. A ventilatory strategy of PHC in preterm infants who receive assisted ventilation is feasible, seems safe, and may reduce the duration of assisted ventilation.