Target PaCO₂ Versus Actual PaCO₂ Values In The Ventilatory Management Of Respiratory Distress Syndrome † 991

Normocapneic ventilatory support is the general goal in the management of respiratory distress syndrome (RDS). In an effort to minimize pulmonary barotauma, many neonatologists are now accepting “higher” values of PaCO₂. We surveyed the physicians (n=6) and the nurse practitioners(n=3) involved with the ventilator decision making process to ascertain individual practitioner and group target PaCO₂ values and weaning thresholds during the acute phase of RDS. Mean target values were compared to actual PaCO₂ values measured in 102 neonates with RDS. The mean birth weight and gestational age was 870±247g and 27±2.6wks. Only babies on conventional mechanical ventilation who received surfactant were included. The target PaCO₂ was determined to be 36 to 46 mmHg. Actual PaCO₂ values are reported in epochs of 6 to 12 hours for the first 3 days of life. Table

Table 1

These data illustrate large standard deviations and therefore show a substantial variance between actual and targeted values for PaCO₂ during the acute phase respiratory support. This variation may be dependent on the operator's ability to predict change in PaCO₂ following an incremental change in the driving pressure. The potential benefits of improving our understanding of the relationship between ventilator changes and PaCO₂ and thereby reducing barotrauma and inadvertent“hyperventilation” needs further study.