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A preterm baby girl born at 25 weeks gestation is 1 week old and remains intubated and ventilated. During the ward round, the consultant discusses the ideal target range of pCO2 and the specialist registrar asks about the use of permissive hypercapnia (PHC).
Structured clinical question
In a preterm infant on respiratory support (patient), what is the optimal pCO2 to prevent (intervention) chronic lung disease and periventricular leukomalacia (outcome)?
PubMed database was searched in July 2016 for the following terms: ‘carbon dioxide’ AND ‘Infants’ AND ‘hypercapnia’. The search returned 292 abstracts, 26 were relevant and appropriate for further review. A search of the Cochrane Library using the search terms ‘carbon dioxide’ AND ‘Infants' AND ‘hypercapnia’ was used yielding one result.
Carbon dioxide (CO2) is a by-product of aerobic breathing; it is carried and dissolved in blood and bound to haemoglobin and plasma proteins. The arterial carbon dioxide level (pCO2) represents the balance between CO2 production and elimination.1 Avery et al2 hypothesised that tolerance of pCO2 above the physiological range may …