PhD Scientific Days 2017

Oral Presentations: Clinical Sciences

Hypoxic-Ischemic Encephalopathy Therapy Optimization in Neonates for Better Neuroprotection with Inhalative CO2

Előadó neve

Dr. Szakmár, Enikő, PhD

Előadó munkahelye

Semmelweis University/ 1st Department of Paediatrics

Előadó telefonszáma

0036307488941

Előadó e-mail címe

szakmar.eniko@med.semmelweis-univ.hu

Az előadás címe

Hypoxic-Ischemic Encephalopathy Therapy Optimization in Neonates for Better Neuroprotection with Inhalative CO2

Szerző(k) neve és munkahelye

Enikő Szakmár 1, Kata Kovács 1, Ünőke Méder 1, Csilla Andorka 1, Miklós Szabó 1, Ágnes Jermendy1
1 Semmelweis University, 1st Department of Paediatrics, Neonatal Intensive Care Unit

Szekció

Oral Presentations: Clinical Sciences

Data of the presenter

Doctoral School of Clinical Medicine
Program: Prevention of Chronic Diseases in Childhood
Supervisor: Ágnes Jermendy
E-mail address: szakmar.eniko@med.semmelweis-univ.hu

Text of the abstract

Introduction: Asphyxiated infants often develop hypocapnia due to hyperventilation driven by severe metabolic acidosis or vigorous mechanical ventilation. Hypocapnia has been consistently associated with adverse neurodevelopmental outcome in clinical trials. Thus, preventing hypocapnia is desirable in asphyxiated infants; however, currently no reliable technique is available to achieve this goal.

Aims: Our aim is to test the feasibility and safety of low concentration of inhalative CO2 gas mixture (5% CO2 + 95% air) in maintaining pCO2 levels in 40-60 mmHg range in asphyxiated, cooled, mechanically ventilated newborns.

Method: Term asphyxiated infants undergoing hypothermia treatment with a pCO2 less than 40 mmHg within 6 hours of life will be enrolled. The 5% CO2 gas mixture is administered through patient circuits in conventional ventilators. The end point of CO2 inhalation is determined by recovery of metabolic acidosis, when base deficit has decreased below 5 mmol/L in the arterial blood. The maximum duration of CO2 exposure is set at 12 hours.

Results: Preliminary results of 4 enrolled patients will be presented. Ventilation with 5% CO2 commenced a median of 4.77 h [4.06; 5.72] after birth and continued for a median 8.29 h [2.27; 12.00]. The 4 patients spent 89% of time in the target pCO2 range (40-60 mmHg). The median time of recovery from acidosis (pH > 7.25) was 9.27 h [2.50; 43.63] after birth. We detected significantly increased respiratory rate and tidal volume during the 5% CO2 inhalation, but there were no adverse events leading to pulmonary or circulatory failure. We did not detect an increase of cerebral blood flow velocity measured in the anterior cerebral artery during the 5% CO2 inhalation.

Conclusion: Inhalative administration of 5% CO2 is a physiologically plausible intervention for preventing hypocapnia. If safety is proven, inhalative CO2 may be used to optimize neuroprotection in asphyxiated newborns.

Kind

Szabad

Előadás fájl jóváhagyás

nem rendelkezett róla

Előadó

1257

Authors (legacy)

Enikő Szakmár 1, Kata Kovács 1, Ünőke Méder 1, Csilla Andorka 1, Miklós Szabó 1, Ágnes Jermendy1
1 Semmelweis University, 1st Department of Paediatrics, Neonatal Intensive Care Unit