Yonsei Med J.  2018 Jan;59(1):101-106. 10.3349/ymj.2018.59.1.101.

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

• Lee SM
• Namgung R
• Eun HS
• Lee SM
• Park MS
• Park KI

• KMID: 2418855
• DOI: http://doi.org/10.3349/ymj.2018.59.1.101

Abstract

PURPOSE
Removal of COâ‚‚ is much efficient during high-frequency oscillatory ventilation (HFOV) for preterm infants. However, an optimal carbon dioxide diffusion coefficient (DCOâ‚‚) and tidal volume (VT) have not yet been established due to much individual variance. This study aimed to analyze DCOâ‚‚ values, VT, and minute volume in very-low-birth-weight (VLBW) infants using HFOV and correlates with plasma COâ‚‚ (pCOâ‚‚).
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 Dräger Babylog VN500 ventilator (Drägerwerk Ag & Co.) in HFOV mode. The normocapnia was indicated as pCO₂ 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 DCOâ‚‚ was 43.5 mL²/s. Mean results of the blood gas test were as follows: pH, 7.31; pCOâ‚‚, 52.6 mm Hg; and SpOâ‚‚, 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 DCOâ‚‚ showed significant difference (68.4±32.7 mL²/s vs. 32.4±15.7 mL²/s). The DCOâ‚‚ was significantly correlated with the pCOâ‚‚ (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.

Keyword

Tidal volume; infant, very low birth weight; ventilation, normocapnia, high frequency oscillatory ventilation

MeSH Terms

Blood Gas Analysis
Carbon Dioxide/analysis
Female
*High-Frequency Ventilation
Humans
Hypercapnia/physiopathology
Incidence
Infant
Infant, Newborn
Infant, Very Low Birth Weight/*physiology
Male
ROC Curve
Tidal Volume
Carbon Dioxide

Figure

• 

  Fig. 1 Correlation analysis between DCO2 and pCO2 and between VT and pCO2. DCO2 values showed negative correlation with pCO2. VT showed negative correlation with pCO2. DCO2, carbon dioxide diffusion coefficient; pCO2, plasma CO2; VT, tidal volume.

• 

  Fig. 2 ROC curve analysis. On the ROC curve analysis, setting of the tidal volume at 1.75 mL/kg was able to maintain normocapnia with a sensitivity of 73%, specificity of 80%, and an AUC of 0.833. ROC, receiver operating characteristic curves; AUC, area under the curve.

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