Related Experiment Video
Updated: Feb 28, 2026
Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department
Published on: January 29, 2011
Using exhaled CO2 to guide initial respiratory support at birth: a randomised controlled trial
Ashley Y Ngan1, Po-Yin Cheung1,2, Ann Hudson-Mason1
1Centre for the Study of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
Insights
Sustained inflation (SI) at birth reduced mechanical ventilation duration in preterm infants. Exhaled carbon dioxide (ECO2)-guided SI showed similar bronchopulmonary dysplasia (BPD) rates compared to positive pressure ventilation (PPV) alone.
Area of Science:
- Neonatal Resuscitation
- Respiratory Support in Preterm Infants
Background:
- Bronchopulmonary dysplasia (BPD) is a significant concern in preterm infants.
- Sustained inflation (SI) at birth is a potential intervention to reduce BPD incidence.
Purpose of the Study:
- To evaluate if SI guided by exhaled carbon dioxide (ECO2) reduces BPD compared to positive pressure ventilation (PPV) alone.
- To assess the feasibility of using ECO2 to guide SI in preterm neonates.
Main Methods:
- A randomized controlled trial involving preterm infants (23-32 weeks gestation) requiring PPV at birth.
- Infants were assigned to either SI group or PPV group.
- SI group received initial SI with ECO2-guided adjustments; PPV group received standard mask PPV.
Main Results:
- No statistically significant difference in BPD rates between SI (23%) and PPV (33%) groups (p=0.090).
- Significantly shorter duration of mechanical ventilation in the SI group (63 hours) compared to the PPV group (204 hours) (p=0.045).
- No short-term adverse effects like pneumothorax or intraventricular hemorrhage were observed with SI.
Conclusions:
- SI at birth, guided by ECO2, resulted in reduced mechanical ventilation duration for preterm infants.
- SI demonstrated similar BPD incidence compared to PPV.
- ECO2-guided SI is a feasible approach for neonatal respiratory support.
Importance:
A sustained inflation (SI) provided at birth might reduce bronchopulmonary dysplasia (BPD).
Objective:
This study aims to examine whether an SI-guided exhaled carbon dioxide (ECO2) compared with positive pressure ventilation (PPV) alone at birth decreases BPD.
Design:
Randomised controlled trial. Infants were randomly allocated to either SI (SI group) or PPV (PPV group).
Participants:
Participants of this study include infants between 23+0 and 32+6 weeks gestation with a need for PPV at birth.
Intervention:
Infants randomised into the SI group received an initial SI with a peak inflation pressure (PIP) of 24 cmH2O over 20 s. The second SI was guided by the amount of ECO2. If ECO2 was ≤20 mm Hg, a further SI of 20 s was delivered. If ECO2 was >20 mm Hg the second SI was 10 s. Infants randomised into the PPV group received mask PPV with an initial PIP of 24 cmH2O.
Primary Outcomes:
Reduction in BPD defined as the need for respiratory support or supplemental oxygen at corrected gestational age of 36 weeks.
Results:
SI (n=76) and PPV (n=86) group had similar rates of BPD (23% vs 33%, p=0.090, not statistically significant). The duration of mechanical ventilation was significantly reduced with SI versus PPV (63 (10-246) hours versus 204 (17-562) hours, respectively (p=0.045)). No short-term harmful effects were identified from two SI lasting up to 40 s (eg, pneumothorax, intraventricular haemorrhage or patent ductus arteriosus).
Conclusion:
Preterm infants <33 weeks gestation receiving SI at birth had lower duration of mechanical ventilation and similar incidence of BPD compared with PPV. Using ECO2 to guide length of SI is feasible.
Trial Registration Number:
NCT01739114; Results.
Related Concept Videos
01:17Assessment of Diffusion and Perfusion
The Role of Diffusion in Respiration
Diffusion is the process by which molecules move from an area of higher concentration to an area of lower concentration. In the respiratory system, this...
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
01:23Physiological Control of Respiration
Breathing, a seemingly passive process, is regulated by the respiratory center in the brainstem. This center coordinates the involuntary control of respirations, which means it occurs without conscious effort, ensuring a smooth and uninterrupted pattern.
Regulation of Ventilation
The body maintains ventilation by monitoring levels of carbon dioxide (CO2), oxygen (O2), and hydrogen ion concentration (pH) in the arterial blood. Among these factors, the level of CO2 plays a crucial...
01:19Respiratory Assessment: Purpose and Indications
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...
01:18Neural Control of Respiration
Respiratory Centers in the Brainstem
Two primary areas comprise the respiratory center: the medullary respiratory center in the medulla oblongata and the pontine respiratory group in the pons. The...