End tidal carbon dioxide levels during the resuscitation of prematurely born infants

TY - JOUR

T1 - End tidal carbon dioxide levels during the resuscitation of prematurely born infants

AU - Murthy, Vadivelam

AU - O'Rourke-Potocki, Anthony

AU - Dattani, Nikesh

AU - Fox, Grenville

AU - Campbell, Morag E.

AU - Milner, Anthony D.

AU - Greenough, Anne

PY - 2012/10

Y1 - 2012/10

N2 - Background: Successful resuscitation of prematurely born infants is dependent on achieving adequate alveolar ventilation and vasodilation of the pulmonary vascular bed. Elevation of end-tidal carbon dioxide (ETCO2) levels may indicate pulmonary vasodilation. Aims: This research aims to study the temporal changes in ETCO2 levels and the infant's respiratory efforts during face mask resuscitation in the labour suite, and to determine if the infant's first inspiratory effort was associated with a rise in the ETCO2 levels, suggesting pulmonary vasodilation had occurred. Study design: This study is an observational one. Subjects: The subjects of the study are forty infants with a median gestational age of 30 weeks (range 23-34). Outcome measures: Inflation pressures, expiratory tidal volumes and ETCO2 levels were measured. Results: The median expiratory tidal volume of inflations prior to the onset of the infant's respiratory efforts (passive inflations) was lower than that of the inflation associated with the first inspiratory effort (active inflation) (1.8 (range 0.1-7.3) versus 6.3 ml/kg (range 1.9-18.4), p<0.001), as were the median ETCO2 levels (0.3 (range 0.1-2.1) versus 3.4 kPa (0.4-11.5), p<0.001). The median expiratory tidal volume (4.5 ml/kg (range 0.5-18.3)) and ETCO2 level (2.2 kPa (range 0.3-9.3)) of the two passive inflations following the first active inflation were also higher than the median expiratory tidal volume and ETCO2 levels of the previous passive inflations (p<0.001, p<0.0001 respectively). Conclusion: These results suggest that during face mask resuscitation, improved carbon dioxide elimination, likely due to pulmonary vasodilation, occurred with the onset of the infant's respiratory efforts.

AB - Background: Successful resuscitation of prematurely born infants is dependent on achieving adequate alveolar ventilation and vasodilation of the pulmonary vascular bed. Elevation of end-tidal carbon dioxide (ETCO2) levels may indicate pulmonary vasodilation. Aims: This research aims to study the temporal changes in ETCO2 levels and the infant's respiratory efforts during face mask resuscitation in the labour suite, and to determine if the infant's first inspiratory effort was associated with a rise in the ETCO2 levels, suggesting pulmonary vasodilation had occurred. Study design: This study is an observational one. Subjects: The subjects of the study are forty infants with a median gestational age of 30 weeks (range 23-34). Outcome measures: Inflation pressures, expiratory tidal volumes and ETCO2 levels were measured. Results: The median expiratory tidal volume of inflations prior to the onset of the infant's respiratory efforts (passive inflations) was lower than that of the inflation associated with the first inspiratory effort (active inflation) (1.8 (range 0.1-7.3) versus 6.3 ml/kg (range 1.9-18.4), p<0.001), as were the median ETCO2 levels (0.3 (range 0.1-2.1) versus 3.4 kPa (0.4-11.5), p<0.001). The median expiratory tidal volume (4.5 ml/kg (range 0.5-18.3)) and ETCO2 level (2.2 kPa (range 0.3-9.3)) of the two passive inflations following the first active inflation were also higher than the median expiratory tidal volume and ETCO2 levels of the previous passive inflations (p<0.001, p<0.0001 respectively). Conclusion: These results suggest that during face mask resuscitation, improved carbon dioxide elimination, likely due to pulmonary vasodilation, occurred with the onset of the infant's respiratory efforts.

KW - Humans

KW - Infant, Newborn

KW - Infant, Premature, Diseases

KW - Resuscitation

KW - Infant, Premature

KW - Male

KW - Female

KW - Tidal Volume

KW - Carbon Dioxide

U2 - 10.1016/j.earlhumdev.2012.05.003

DO - 10.1016/j.earlhumdev.2012.05.003

M3 - Article

C2 - 22641276

SN - 0378-3782

VL - 88

SP - 783

EP - 787

JO - Early Human Development

JF - Early Human Development

IS - 10

ER -