PCO2 Fluctuation and Severe IVH

Fabres J, Carlo WA, Phillips V, et al. Both Extremes of Arterial Carbon Dioxide Pressure and the Magnitude of Fluctuations in Arterial Carbon Dioxide Pressure Are Associated With Severe Intraventricular Hemorrhage in Preterm Infants. PEDIATRICS (Feb 2007); 119: 299-305. [Full text] [PDF]

OBJECTIVE. The goal was to test the hypothesis that extremes of PaCO2 during the first 4 days after birth are associated with severe intraventricular hemorrhage (grades 3 and 4).

METHODS. A single-center retrospective review of clinical and blood gas data in the first 4 postnatal days for 849 infants with birth weights of 401 to 1250 g was performed. The univariate and multivariate relationships of severe intraventricular hemorrhage with maximal and minimal PaCO2, PaCO2 averaged over time (time-weighted PaCO2), and measures of PaCO2 fluctuation (SD of PaCO2 and difference in PaCO2 [maximum minus minimum]) were assessed.

RESULTS. Birth weight (mean ± SD) was 848 ± 212 g, and the median gestational age was 26 weeks. Infants with severe intraventricular hemorrhage had higher maximal PaCO2 (median: 72 vs. 59 mm Hg) and time-weighted PaCO2 (mean: 49 vs. 47 mm Hg) values but lower minimal PaCO2 values (32 vs. 37 mm Hg). High PaCO2, low PaCO2, SD of PaCO2, and difference in PaCO2 predicted severe intraventricular hemorrhage, but time-weighted average PaCO2 was not as predictive.

CONCLUSIONS. Both extremes and fluctuations of PaCO2 are associated with severe intraventricular hemorrhage. It may be prudent to avoid extreme hypocapnia and hypercapnia during the period of risk for intraventricular hemorrhage.

Comments: Severe IVH was associated with higher maximum pCO2, lower minimum pCO2, and greater fluctuation of pCO2. This is likely to be related to the effects of pCO2 on cerebral blood flow. In order to avoid these fluctuations in pCO2, we need to be able to monitor and trend our pCO2 continuously. Should all very low birth weight infants be kept on transcutaneous or end-tidal pCO2 monitors during the first 4 days of life?? ABK

I think that all sick premature newborns should be on end-tidal co2 check. As the fluctuation in pco2 is really harmful to VLBW and ELBW babies, it is better to do that. It would also avoid unnecessary blood checks for repeated gases.

UserName: Dr. Junaid M Khan
Institution: Al-Rahba Hospital
email: junaidmuhib@yahoo.com

Date: 13 Feb 2007
Time: 08:16:32

How about using the information we gain from flow sensors - TV / MV rtaher than adding further dead space/skin stickers in these infants.

UserName: Birgit Wefers
Institution: Queen Mothers Hospital, Glasgow, UK
telephone: 0141-2010000
email: bwefers@doctors.org.uk

Date: 21 Mar 2007
Time: 11:02:57

PCO2 fluctuations suggests a very sick baby . In these babies it is hard to provide an optimal ventilation . so , who is the chicken and who is the egg? Of course if you ventilate the baby better the chance of developing IVH , ROP and even NEC is decreased.

UserName: Avi Rotschild
Institution: Carmel Medical Center , Haifa , Israel
telephone: 972 4 8250611
email: jorothsi@netvision.net.cl

Date: 06 Apr 2007
Time: 23:25:26

IN VOLUME GUARANTEE VENTILATION FLUCTUATION OF PCO2 IS MINIMAL. THIS ALONG WITH CONTINUOUS MONITORING OF ETCO2 WILL DECREASE IVH IN PRETERM BABIES.

UserName: DR.PRAKASH C VAGHELA
Institution: KALARAV CHILDREN HOSPITAL
telephone: 0278 2433636
email: prakash_vghl@yahoo .co.in

Date: 10 Apr 2007
Time: 00:31:58

End-tidal CO² measurement is only a reliable estimate for blood gases if gas exchange in the lung is adequate. In severe sick patients with disturbed ventilation, low endtidal CO² is found, however, PaCO² is elevated. Furthermore, sensor adds another dead space. Thus, whenever possible, transcutaneous measurements should be used.

UserName: Mario Rüdiger
Institution: Medical University Innsbruck
telephone: 0043-51250481644
email: mario.ruediger@uibk.ac.at

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