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Effective Tidal Volume for Normocapnia in Very-Low-Birth-Weight Infants Using High-Frequency Oscillatory Ventilation

 Seul Mi Lee  ;  Ran Namgung  ;  Ho Sun Eun  ;  Soon Min Lee  ;  Min Soo Park  ;  Kook In Park 
 YONSEI MEDICAL JOURNAL, Vol.59(1) : 101-106, 2018 
Journal Title
Issue Date
Blood Gas Analysis ; Carbon Dioxide/analysis ; Female ; *High-Frequency Ventilation ; Humans ; Hypercapnia/physiopathology ; Incidence ; Infant ; Newborn Infant ; Very Low Birth Weight/*physiology Infant ; Male ; ROC Curve ; Tidal Volume
Tidal volume ; very low birth weight infant ; normocapnia ventilation, high frequency oscillatory ventilation
PURPOSE: Removal of CO(2) is much efficient during high-frequency oscillatory ventilation (HFOV) for preterm infants. However, an optimal carbon dioxide diffusion coefficient (DCO(2)) and tidal volume (VT) have not yet been established due to much individual variance. This study aimed to analyze DCO(2) values, VT, and minute volume in very-low-birth-weight (VLBW) infants using HFOV and correlates with plasma CO(2) (pCO(2)). MATERIALS AND METHODS: Daily respiratory mechanics and ventilator settings from twenty VLBW infants and their two hundred seventeen results of blood gas analysis were collected. Patients were treated with the Drager Babylog VN500 ventilator (Dragerwerk Ag & Co.) in HFOV mode. The normocapnia was indicated as pCO(2) ranging from 45 mm Hg to 55 mm Hg. RESULTS: The measured VT was 1.7 mL/kg, minute volume was 0.7 mL/kg, and DCO(2) was 43.5 mL(2)/s. Mean results of the blood gas test were as follows: pH, 7.31; pCO(2), 52.6 mm Hg; and SpO(2), 90.5%. In normocapnic state, the mean VT was significantly higher than in hypercapnic state (2.1+/-0.5 mL/kg vs. 1.6+/-0.3 mL/kg), and the mean DCO(2) showed significant difference (68.4+/-32.7 mL(2)/s vs. 32.4+/-15.7 mL(2)/s). The DCO(2) was significantly correlated with the pCO(2) (p=0.024). In the receiver operating curve analysis, the estimated optimal cut-off point to predict the remaining normocapnic status was a VT of 1.75 mL/kg (sensitivity 73%, specificity 80%). CONCLUSION: In VLBW infants treated with HFOV, VT of 1.75 mL/kg is recommended for maintaining proper ventilation.
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1. College of Medicine (의과대학) > Dept. of Pediatrics (소아청소년과학교실) > 1. Journal Papers
Yonsei Authors
Namgung, Ran(남궁란) ORCID logo https://orcid.org/0000-0001-7182-9535
Park, Kook In(박국인) ORCID logo https://orcid.org/0000-0001-8499-9293
Park, Min Soo(박민수) ORCID logo https://orcid.org/0000-0002-4395-9938
Eun, Ho Seon(은호선) ORCID logo https://orcid.org/0000-0001-7212-0341
Lee, Soon Min(이순민) ORCID logo https://orcid.org/0000-0003-0174-1065
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