We tested the feasibility of reversed-flow tracheal gas insufflation(RF-TGI) in ventilated neonatal and pediatric patients. Five patients with uncontrollable hypercapnia were tested: a 2-year old child, a 52-day old infant, and 3 premature infants (29, 29 and 26 weeks gestation; 1300 g, 1100 g and 890 g). RF-TGI was applied for 9.5, 8, 25, 72 and 60 hrs, respectively. An intratracheal catheter (COOK Inc.) with a reversed continuous flow of gas at its tip (away from lungs) allowed flushing of CO2 from the proximal dead space. Results: Marked reductions in PaCO2 ranging from 37 to 71% and improvement in pH were achieved within 4 hours of applying RF-TGI. Means ± standard deviations are presented below: Table

Table 1
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In four patients, despite significant reductions in PaCO2, there was no substantial improvement in baseline condition (shock and severe metabolic acidosis) and they were switched back to conventional ventilation. This led to worsening hypercapnia to pre- RF-TGI values. These 4 patients subsequently expired. One premature infant survived, was successfully weaned to conventional ventilation and was eventually discharged home.Conclusion: RF-TGI can alleviate uncontrollable hypercapnia in ventilated neonatal and pediatric patients. Speculation: It is possible that these patients were already too ill to derive significant benefit from the technique. We speculate that application of RF-TGI earlier in the clinical course would be associated with greater improvement in overall morbidity and mortality.