PaCO2 in surfactant, positive pressure, and oxygenation randomised trial (SUPPORT)

Academic Article

Abstract

  • Objective: To determine the association of arterial partial pressure of carbon dioxide PaCO with severe intraventricular haemorrhage (sIVH), bronchopulmonary dysplasia (BPD), and neurodevelopmental impairment (NDI) at 18-22 months in premature infants. Design: Secondary exploratory data analysis of Surfactant, Positive Pressure, and Oxygenation Randomised Trial (SUPPORT). Setting Patients: Multiple referral neonatal intensive care units. 1316 infants 24 0/7 to 27 6/7 weeks gestation randomised to different oxygenation (SpO target 85-89% vs 91-95%) and ventilation strategies. Main outcome measures: Blood gases from postnatal day 0 to day14 were analysed. Five PaCO variables were defined: minimum (Min), maximum (Max), SD, average (time-weighted), and a four level categorical variable (hypercapnic (highest quartile of Max PaCO ), hypocapnic (lowest quartile of Min PaCO ), fluctuators (hypercapnia and hypocapnia), and normocapnic (middle two quartiles of Max and Min PaCO )). PaCO variables were compared for infants with and without sIVH, BPD and NDI (┬▒death). Multivariable logistic regression models were developed for adjusted results. Results: sIVH, BPD and NDI (┬▒death) were associated with hypercapnic infants and fluctuators. Association of Max PaCO and outcomes persisted after adjustment (per 10 mm Hg increase: sIVH/death: OR 1.27 (1.13 to 1.41); BPD/death: OR 1.27 (1.12 to 1.44); NDI/death: OR 1.23 (1.10 to 1.38), death: OR 1.27 (1.12 to 1.44), all p<0.001). No interaction was found between PaCO category and SpO treatment group for sIVH/death, NDI/death or death. Max PaCO was positively correlated with maximum FiO (r 0.55, p<0.0001) and ventilator days (rs0.61, p<0.0001). Conclusions: Higher PaCO was an independent predictor of sIVH/death, BPD/death and NDI/death. Further trials are needed to evaluate optimal PaCO targets for high-risk infants. 2 2 2 2 2 2 2 2 2 2 2 2 s 2 2
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    Author List

  • Ambalavanan N; Carlo WA; Wrage LA; Das A; Laughon M; Cotten CM; Kennedy KA; Laptook AR; Shankaran S; Walsh MC
  • Start Page

  • F145
  • End Page

  • F149
  • Volume

  • 100
  • Issue

  • 2