Permisivna hiperkapnija-strategija tretmana mehaniÄki ventilirane nedonoÅ¡Äadi

Abstract

Advanced in perinatal care such as surfacant, antenatal steroids, and improved ventilatory suport have markedly reduced mortality rates of premature infants, allowing the survival of many critically ill infants. But, the improved survival of these vulbnerable newbrns has increased the number of infants at risk for various forms of respiratory morbidities including brnochopulmonry displasia and lear leaks. There are physiological rationale and experimantal data that sugest permissive hypercapnia may be well tolerated and result in reduced lung injury in mehanical ventilated premature newborns. Permissive hypercapnia or controlled ventilation is a strategy that minimize baro/volutrauma by allowing relativly high level of arterial CO₂, provided that arterial pH does not fall bellow a preset minimal value. Gradual small elevations in pCO₂ are relatively safe as long as the pH stops above 7.20. Thus, in permissive hypercapnia priority is given to the prevention or limitation of overventilation rather than maintenace of normal blood gases and alveolar ventilation. Mild to moderate alveolar hyoventilation and respiratory acidosis may be well tolerated and my lead to prevention of pulmoray volutrauma in premature infants. There is need for futher research testing to determine the appropriate clinical application of permisive hypercapnia, the optimal level of hypercapnic acidosis, without an increased risk of impaired neurodevelopment or other adverse efects.