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

Vadivelam Murthy, Anthony O'Rourke-Potocki, Nikesh Dattani, Grenville F Fox, Morag E Campbell, Anthony D Milner, Anne Greenough
Early Human Development 2012, 88 (10): 783-7

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 (ETCO(2)) levels may indicate pulmonary vasodilation.

AIMS: This research aims to study the temporal changes in ETCO(2) 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 ETCO(2) 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 ETCO(2) 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 ETCO(2) 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 ETCO(2) 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 ETCO(2) 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.

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