Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, Alabama, USA
Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, Alabama, USA.
Arch Dis Child Fetal Neonatal Ed. 2023 Sep;108(5):530-534. doi: 10.1136/archdischild-2022-325166. Epub 2023 Mar 13.
Determine if targeting higher transcutaneous carbon dioxide improves respiratory stability among very preterm infants on ventilatory support.
Single-centre pilot randomised clinical trial.
The University of Alabama at Birmingham.
Very preterm infants on ventilatory support after postnatal day 7.
Infants were randomised to two different transcutaneous carbon dioxide levels targeting 5 mm Hg (0.67 kPa) changes with four sessions each lasting 24 hours for 96 hours: baseline-increase-baseline-increase or baseline-decrease-baseline-decrease.
We collected cardiorespiratory data evaluating episodes of intermittent hypoxaemia (oxygen saturations (SpO)<85% for ≥10 s), bradycardia (<100 bpm for ≥10 s), and cerebral and abdominal hypoxaemia on near-infrared spectroscopy.
We enrolled 25 infants with a gestational age of 24 w 6 d±11 d (mean±SD) and birth weight 645±142 g on postnatal day 14±3. Continuous transcutaneous carbon dioxide values (56.8±6.9 in the higher group vs 54.5±7.8 in the lower group; p=0.36) did not differ significantly between groups during the intervention days. There were no differences in intermittent hypoxaemia (126±64 vs 105±61 per 24 hours; p=0.30) or bradycardia (11±16 vs 15±23 per hour; p=0.89) episodes between groups. The proportion of time with SpO<85%, SpO<80%, cerebral hypoxaemia or abdominal hypoxaemia did not differ (all p>0.05). There was moderate negative correlation between mean transcutaneous carbon dioxide and bradycardia episodes (r=-0.56; p<0.001).
Targeting 5 mm Hg (0.67 kPa) changes in transcutaneous carbon dioxide did not improve respiratory stability among very preterm infants on ventilatory support but the intended carbon dioxide separation was difficult to achieve and maintain.
NCT03333161.
确定在接受通气支持的极早产儿中，将经皮二氧化碳目标值提高是否能改善呼吸稳定性。
单中心先导随机临床试验。
阿拉巴马大学伯明翰分校。
出生后 7 天以上接受通气支持的极早产儿。
将婴儿随机分配到两种不同的经皮二氧化碳水平，每个水平持续 24 小时，共 4 个疗程，每个疗程相隔 24 小时，分别为：基线-增加-基线-增加或基线-减少-基线-减少。
我们收集了心肺数据，评估间歇性低氧血症（氧饱和度（SpO2）<85%，持续时间≥10s）、心动过缓（<100bpm，持续时间≥10s）以及近红外光谱脑和腹部低氧血症的发作情况。
我们共纳入 25 名胎龄为 24 周 6 天±11 天（均值±标准差）、出生体重为 645g±142g 的婴儿，出生后第 14 天±3 天接受了通气支持。在干预期间，连续经皮二氧化碳值（高组为 56.8±6.9mmHg，低组为 54.5±7.8mmHg；p=0.36）在两组间无显著差异。间歇性低氧血症（每 24 小时 126±64 次 vs 105±61 次；p=0.30）或心动过缓（每小时 11±16 次 vs 15±23 次；p=0.89）发作次数在两组间无差异。SpO2<85%、SpO2<80%、脑缺氧或腹部缺氧的时间比例无差异（均 p>0.05）。经皮二氧化碳的平均值与心动过缓发作之间存在中度负相关（r=-0.56；p<0.001）。
将经皮二氧化碳目标值提高 5mmHg（0.67kPa）并不能改善接受通气支持的极早产儿的呼吸稳定性，但目标值的二氧化碳分离很难实现和维持。
NCT03333161。
