PACULit Daily Literature Update: Late Permissive Hypercapnia for Mechanically Ventilated Preterm Infants A Randomized Trial Quiz

A 25-week gestational age male preterm infant weighing 700 grams is mechanically ventilated for respiratory distress syndrome. On postnatal day 8, the neonatal intensive care team is considering adjusting ventilator settings to optimize respiratory outcomes. The infant currently has a PCO2 of 50 mmHg and a pH of 7.28. The clinical pharmacist is consulted to recommend an evidence-based target for permissive hypercapnia to potentially reduce ventilation duration.

Based on the recent randomized trial by Travers et al., what pH-controlled PCO2 target range should the pharmacist recommend to increase ventilator-free days in this preterm infant?

A 24-week gestational age female preterm infant on mechanical ventilation has been managed with a higher permissive hypercapnia strategy (PCO2 65 mmHg, pH 7.22) since postnatal day 7. The clinical team is reviewing the infant’s risk for bronchopulmonary dysplasia (BPD) and mortality before discharge. The pharmacist is asked to counsel on the expected impact of this ventilation strategy on BPD incidence and survival.

What does the evidence from the randomized trial suggest about the incidence of Grade 2-3 BPD or death before discharge in infants managed with higher pH-controlled permissive hypercapnia compared to lower targets?

A 23-week gestational age preterm infant on mechanical ventilation is being managed with late permissive hypercapnia targeting PCO2 70 mmHg and pH ≥ 7.20. The pharmacist is preparing to counsel the neonatal team on safety considerations and monitoring parameters, including potential neurodevelopmental risks and CO2 level thresholds.

According to current evidence and related research, what is an important consideration when implementing late permissive hypercapnia in mechanically ventilated preterm infants?