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Updated: Jul 26, 2025
Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department
Published on: January 29, 2011
Carbon Dioxide Level between Nasal High-Frequency Oscillatory Ventilation and Synchronized Nasal Intermittent
Kulthida Baingam1, Manapat Phatigomet1, Anucha Thatrimontrichai1
1Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Objective:
Nasal high-frequency oscillatory ventilation (nHFOV) and synchronized nasal intermittent positive pressure ventilation (sNIPPV) yield a lower partial pressure of carbon dioxide (pCO2) after extubation than nasal continuous positive airway pressure. Our aim was to clarify which of the two was superior.
Study Design:
We performed a crossover randomized study to evaluate pCO2 level among 102 participants from July 2020 to June 2022. Intubated preterm and term neonates with arterial lines were randomly allocated to nHFOV-sNIPPV or sNIPPV-nHFOV sequences; their pCO2 levels were measured after 2 hours in each mode. Subgroup analyses were performed for preterm (gestational age <37 weeks) and very preterm (gestational age <32 weeks) neonates.
Results:
The mean gestational age (nHFOV-sNIPPV, 32.8 vs. sNIPPV-nHFOV, 33.5 weeks) and median birth weight (1,850 vs. 1,930 g) did not differ between the sequences. The mean ± standard deviation pCO2 level after nHFOV (38.7 ± 8.8 mm Hg) was significantly higher than that after sNIPPV (36.8 ± 10.2 mm Hg; mean difference: 1.9 mm Hg; 95% confidence interval: 0.3-3.4 mm Hg; treatment effect [p = 0.007] but no sequence [p = 0.92], period [p = 0.53], or carryover [p = 0.94] effects). However, the difference in pCO2 level between the sequences was not statistically significant in the subgroup analyses of preterm and very preterm neonates.
Conclusion:
After neonatal extubation, the sNIPPV mode was associated with a lower pCO2 level than the nHFOV mode with no significant difference in preterm and very preterm neonates.
Key Points:
· Full noninvasive ventilation support is suggested in neonatal ventilation.. · pCO2 level in sNIPPV was lower than in nHFOV.. · No differences in pCO2 levels were observed in either preterm or very preterm neonates..
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