Permissive hypercapnia in preterm infants: the discussion continues

摘要

During the past decade the threshold of viability in extremely preterm infants has shifted to the lower gestational age of younger than 26 weeks postmenstrual age with subsequent improved survival. As a consequence, more of the survivors have to be treated for typical co-morbidities of extreme prematurity such as brochopulmonary dysplasia. The latter is associated with extreme prematurity and ventilator-induced lung injury. Data from small studies have suggested that permissive hypercapnia might reduce the incidence of lung injury, and as a result the German multicentre PHELBI study group1 embarked on a large randomised controlled study of 830 extremely low birthweight infants testing two levels of partial pressures of carbon dioxide (PCO2) during the first 2 weeks of life. The study was stopped prematurely after an interim analysis of 359 (23%) of 1534 infants screened in 53 months, in which investigators noted no difference in the primary outcome of death or moderate to severe bronchopulmonary dysplasia between groups.