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PaCO2 in surfactant, positive pressure, and oxygenation randomised trial (SUPPORT).

Publication ,  Journal Article
Ambalavanan, N; Carlo, WA; Wrage, LA; Das, A; Laughon, M; Cotten, CM; Kennedy, KA; Laptook, AR; Shankaran, S; Walsh, MC; Higgins, RD ...
Published in: Arch Dis Child Fetal Neonatal Ed
March 2015

OBJECTIVE: To determine the association of arterial partial pressure of carbon dioxide PaCO2 with severe intraventricular haemorrhage (sIVH), bronchopulmonary dysplasia (BPD), and neurodevelopmental impairment (NDI) at 18-22 months in premature infants. DESIGN: Secondary exploratory data analysis of Surfactant, Positive Pressure, and Oxygenation Randomised Trial (SUPPORT). SETTING: Multiple referral neonatal intensive care units. PATIENTS: 1316 infants 24 0/7 to 27 6/7 weeks gestation randomised to different oxygenation (SpO2 target 85-89% vs 91-95%) and ventilation strategies. MAIN OUTCOME MEASURES: Blood gases from postnatal day 0 to day14 were analysed. Five PaCO2 variables were defined: minimum (Min), maximum (Max), SD, average (time-weighted), and a four level categorical variable (hypercapnic (highest quartile of Max PaCO2), hypocapnic (lowest quartile of Min PaCO2), fluctuators (hypercapnia and hypocapnia), and normocapnic (middle two quartiles of Max and Min PaCO2)). PaCO2 variables were compared for infants with and without sIVH, BPD and NDI (±death). Multivariable logistic regression models were developed for adjusted results. RESULTS: sIVH, BPD and NDI (±death) were associated with hypercapnic infants and fluctuators. Association of Max PaCO2 and outcomes persisted after adjustment (per 10 mm Hg increase: sIVH/death: OR 1.27 (1.13 to 1.41); BPD/death: OR 1.27 (1.12 to 1.44); NDI/death: OR 1.23 (1.10 to 1.38), death: OR 1.27 (1.12 to 1.44), all p<0.001). No interaction was found between PaCO2 category and SpO2 treatment group for sIVH/death, NDI/death or death. Max PaCO2 was positively correlated with maximum FiO2 (rs0.55, p<0.0001) and ventilator days (rs0.61, p<0.0001). CONCLUSIONS: Higher PaCO2 was an independent predictor of sIVH/death, BPD/death and NDI/death. Further trials are needed to evaluate optimal PaCO2 targets for high-risk infants.

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Published In

Arch Dis Child Fetal Neonatal Ed

DOI

EISSN

1468-2052

Publication Date

March 2015

Volume

100

Issue

2

Start / End Page

F145 / F149

Location

England

Related Subject Headings

  • United States
  • Pulmonary Surfactants
  • Prognosis
  • Positive-Pressure Respiration
  • Pediatrics
  • Partial Pressure
  • Oxygen Inhalation Therapy
  • Male
  • Intensive Care Units, Neonatal
  • Infant, Premature, Diseases
 

Citation

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Ambalavanan, N., Carlo, W. A., Wrage, L. A., Das, A., Laughon, M., Cotten, C. M., … SUPPORT Study Group of the NICHD Neonatal Research Network, . (2015). PaCO2 in surfactant, positive pressure, and oxygenation randomised trial (SUPPORT). Arch Dis Child Fetal Neonatal Ed, 100(2), F145–F149. https://doi.org/10.1136/archdischild-2014-306802
Ambalavanan, Namasivayam, Waldemar A. Carlo, Lisa A. Wrage, Abhik Das, Matthew Laughon, C Michael Cotten, Kathleen A. Kennedy, et al. “PaCO2 in surfactant, positive pressure, and oxygenation randomised trial (SUPPORT).Arch Dis Child Fetal Neonatal Ed 100, no. 2 (March 2015): F145–49. https://doi.org/10.1136/archdischild-2014-306802.
Ambalavanan N, Carlo WA, Wrage LA, Das A, Laughon M, Cotten CM, et al. PaCO2 in surfactant, positive pressure, and oxygenation randomised trial (SUPPORT). Arch Dis Child Fetal Neonatal Ed. 2015 Mar;100(2):F145–9.
Ambalavanan, Namasivayam, et al. “PaCO2 in surfactant, positive pressure, and oxygenation randomised trial (SUPPORT).Arch Dis Child Fetal Neonatal Ed, vol. 100, no. 2, Mar. 2015, pp. F145–49. Pubmed, doi:10.1136/archdischild-2014-306802.
Ambalavanan N, Carlo WA, Wrage LA, Das A, Laughon M, Cotten CM, Kennedy KA, Laptook AR, Shankaran S, Walsh MC, Higgins RD, SUPPORT Study Group of the NICHD Neonatal Research Network. PaCO2 in surfactant, positive pressure, and oxygenation randomised trial (SUPPORT). Arch Dis Child Fetal Neonatal Ed. 2015 Mar;100(2):F145–F149.

Published In

Arch Dis Child Fetal Neonatal Ed

DOI

EISSN

1468-2052

Publication Date

March 2015

Volume

100

Issue

2

Start / End Page

F145 / F149

Location

England

Related Subject Headings

  • United States
  • Pulmonary Surfactants
  • Prognosis
  • Positive-Pressure Respiration
  • Pediatrics
  • Partial Pressure
  • Oxygen Inhalation Therapy
  • Male
  • Intensive Care Units, Neonatal
  • Infant, Premature, Diseases