PaCO2 in surfactant, positive pressure, and oxygenation randomised trial (SUPPORT)
Namasivayam Ambalavanan, Waldemar A Carlo, Lisa A Wrage, Abhik Das, Matthew Laughon, C Michael Cotten, Kathleen A Kennedy, Abbot R Laptook, Seetha Shankaran, Michele C Walsh, Rosemary D Higgins, SUPPORT Study Group of the NICHD Neonatal Research Network, Alan H Jobe, Michael S Caplan, Abbot R Laptook, William Oh, Betty R Vohr, Angelita M Hensman, Bonnie E Stephens, Barbara Alksninis, Susan G Barnett, William J Cashore, Melinda Caskey, Regina A Gargus, Daniel J Gingras, Katharine Johnson, Shabnam Lainwala, Theresa M Leach, Martha R Leonard, Sarah Lillie, James R Moore, Lucy Noel, Rachel V Walden, Victoria E Watson, Michele C Walsh, Avroy A Fanaroff, Deanne E Wilson-Costello, Nancy S Newman, Bonnie S Siner, Arlene Zadell, Juliann Di Fiore, Monika Bhola, Harriet G Friedman, Gulgun Yalcinkaya, Kurt Schibler, Edward F Donovan, Kimberly Yolton, Kate Bridges, Barbara Alexander, Cathy Grisby, Marcia Worley Mersmann, Holly L Mincey, Jody Hessling, Teresa L Gratton, Ronald N Goldberg, C Michael Cotten, Ricki F Goldstein, Patricia L Ashley, Kathy J Auten, Kimberley A Fisher, Katherine A Foy, Sharon Fridovich Freedman, Kathryn E Gustafson, Melody B Lohmeyer, William F Malcolm, David K Wallace, Barbara J Stoll, Susie Buchter, Anthony J Piazza, David P Carlton, Ira Adams-Chapman, Sheena L Carter, Ellen C Hale, Amy K Hutchinson, Maureen Mulligan LaRossa, Stephanie Wilson Archer, Brenda B Poindexter, Anna M Dusick, James A Lemons, Leslie D Wilson, Faithe Hamer, Ann B Cook, Dianne E Herron, Carolyn Lytle, Heike M Minnich, Abhik Das, W Kenneth Poole, Marie G Gantz, Jamie E Newman, Betty K Hastings, Jeanette O'Donnell Auman, Carolyn Petrie Huitema, James W Pickett 2nd, Dennis Wallace, Kristin M Zaterka-Baxter, Krisa P Van Meurs, David K Stevenson, Susan R Hintz, M Bethany Ball, Barbara Bentley, Elizabeth F Bruno, Alexis S Davis, Maria Elena DeAnda, Anne M DeBattista, Jean G Kohn, Melinda S Proud, Renee P Pyle, Nicholas H St John, Hali E Weiss, Ivan D Frantz, John M Fiascone, Elisabeth C McGowan, Anne Furey, Brenda L MacKinnon, Ellen Nylen, Ana Brussa, Cecelia Sibley, Waldemar A Carlo, Namasivayam Ambalavanan, Myriam Peralta-Carcelen, Monica V Collins, Shirley S Cosby, Vivien A Phillips, Kirstin J Bailey, Fred J Biasini, Kristen C Johnston, Sara Krzywanski, Kathleen G Nelson, Cryshelle S Patterson, Richard V Rector, Leslie Rodrigues, Amanda D Soong, Sally Whitley, Sheree Chapman York, Neil N Finer, Maynard R Rasmussen, Paul R Wozniak, Yvonne E Vaucher, Wade Rich, Kathy Arnell, Renee Bridge, Clarence Demetrio, Martha G Fuller, Paul Zlotnik, Edward F Bell, John A Widness, Jonathan M Klein, Michael J Acarregui, Tarah T Colaizy, Karen J Johnson, Diane L Eastman, Shahnaz Duara, Charles R Bauer, Ruth Everett-Thomas, Maria Calejo, Alexis N Diaz, Silvia M Frade Eguaras, Andrea Garcia, Kasey Hamlin-Smith, Michelle Harwood Berkowits, Sylvia Fajardo-Hiriart, Elaine E Mathews, Helina Pierre, Arielle Riguard, Alexandra Stroerger, Kristi L Watterberg, Robin K Ohls, Janell Fuller, Conra Backstrom Lacy, Jean Lowe, Rebecca Montman, Dale L Phelps, Gary J Myers, Gary David Markowitz, Linda J Reubens, Diane Hust, Julie Babish Johnson, Erica Burnell, Rosemary L Jensen, Emily Kushner, Joan Merzbach, Kelley Yost, Pablo J Sánchez, Charles R Rosenfeld, Walid A Salhab, Roy J Heyne, Luc P Brion, Sally S Adams, James Allen, Laura Grau, Alicia Guzman, Gaynelle Hensley, Elizabeth T Heyne, Melissa H Leps, Linda A Madden, Melissa Swensen Martin, Nancy A Miller, Janet S Morgan, Araceli Solis, Lizette E Torres, Catherine Twell Boatman, Diana M Vasil, Kathleen A Kennedy, Jon E Tyson, Nora I Alaniz, Patricia W Evans, Beverly Foley Harris, Charles Green, Margarita Jiminez, Anna E Lis, Sarah Martin, Georgia E McDavid, Brenda H Morris, Margaret L Poundstone, Stacy Reddoch, Saba Siddiki, Patti L Pierce Tate, Laura L Whitely, Sharon L Wright, Roger G Faix, Bradley A Yoder, Shawna Baker, Karie Bird, Jill Burnett, Karen A Osborne, Cynthia Spencer, Michael Steffen, Kimberlee Weaver-Lewis, T Michael O'Shea, Robert G Dillard, Lisa K Washburn, Nancy J Peters, Barbara G Jackson, Korinne Chiu, Deborah Evans Allred, Donald J Goldstein, Raquel Halfond, Carroll Peterson, Ellen L Waldrep, Cherrie D Welch, Melissa Whalen Morris, Gail Wiley Hounshell, Seetha Shankaran, Beena G Sood, Athina Pappas, Rebecca Bara, Laura A Goldston, Mary E Johnson, Richard A Ehrenkranz, Vineet Bhandari, Harris C Jacobs, Pat Cervone, Patricia Gettner, Monica Konstantino, JoAnn Poulsen, Janet Taft, Christine G Butler, Nancy Close, Walter Gilliam, Sheila Greisman, Elaine Romano, Joanne Williams, Namasivayam Ambalavanan, Waldemar A Carlo, Lisa A Wrage, Abhik Das, Matthew Laughon, C Michael Cotten, Kathleen A Kennedy, Abbot R Laptook, Seetha Shankaran, Michele C Walsh, Rosemary D Higgins, SUPPORT Study Group of the NICHD Neonatal Research Network, Alan H Jobe, Michael S Caplan, Abbot R Laptook, William Oh, Betty R Vohr, Angelita M Hensman, Bonnie E Stephens, Barbara Alksninis, Susan G Barnett, William J Cashore, Melinda Caskey, Regina A Gargus, Daniel J Gingras, Katharine Johnson, Shabnam Lainwala, Theresa M Leach, Martha R Leonard, Sarah Lillie, James R Moore, Lucy Noel, Rachel V Walden, Victoria E Watson, Michele C Walsh, Avroy A Fanaroff, Deanne E Wilson-Costello, Nancy S Newman, Bonnie S Siner, Arlene Zadell, Juliann Di Fiore, Monika Bhola, Harriet G Friedman, Gulgun Yalcinkaya, Kurt Schibler, Edward F Donovan, Kimberly Yolton, Kate Bridges, Barbara Alexander, Cathy Grisby, Marcia Worley Mersmann, Holly L Mincey, Jody Hessling, Teresa L Gratton, Ronald N Goldberg, C Michael Cotten, Ricki F Goldstein, Patricia L Ashley, Kathy J Auten, Kimberley A Fisher, Katherine A Foy, Sharon Fridovich Freedman, Kathryn E Gustafson, Melody B Lohmeyer, William F Malcolm, David K Wallace, Barbara J Stoll, Susie Buchter, Anthony J Piazza, David P Carlton, Ira Adams-Chapman, Sheena L Carter, Ellen C Hale, Amy K Hutchinson, Maureen Mulligan LaRossa, Stephanie Wilson Archer, Brenda B Poindexter, Anna M Dusick, James A Lemons, Leslie D Wilson, Faithe Hamer, Ann B Cook, Dianne E Herron, Carolyn Lytle, Heike M Minnich, Abhik Das, W Kenneth Poole, Marie G Gantz, Jamie E Newman, Betty K Hastings, Jeanette O'Donnell Auman, Carolyn Petrie Huitema, James W Pickett 2nd, Dennis Wallace, Kristin M Zaterka-Baxter, Krisa P Van Meurs, David K Stevenson, Susan R Hintz, M Bethany Ball, Barbara Bentley, Elizabeth F Bruno, Alexis S Davis, Maria Elena DeAnda, Anne M DeBattista, Jean G Kohn, Melinda S Proud, Renee P Pyle, Nicholas H St John, Hali E Weiss, Ivan D Frantz, John M Fiascone, Elisabeth C McGowan, Anne Furey, Brenda L MacKinnon, Ellen Nylen, Ana Brussa, Cecelia Sibley, Waldemar A Carlo, Namasivayam Ambalavanan, Myriam Peralta-Carcelen, Monica V Collins, Shirley S Cosby, Vivien A Phillips, Kirstin J Bailey, Fred J Biasini, Kristen C Johnston, Sara Krzywanski, Kathleen G Nelson, Cryshelle S Patterson, Richard V Rector, Leslie Rodrigues, Amanda D Soong, Sally Whitley, Sheree Chapman York, Neil N Finer, Maynard R Rasmussen, Paul R Wozniak, Yvonne E Vaucher, Wade Rich, Kathy Arnell, Renee Bridge, Clarence Demetrio, Martha G Fuller, Paul Zlotnik, Edward F Bell, John A Widness, Jonathan M Klein, Michael J Acarregui, Tarah T Colaizy, Karen J Johnson, Diane L Eastman, Shahnaz Duara, Charles R Bauer, Ruth Everett-Thomas, Maria Calejo, Alexis N Diaz, Silvia M Frade Eguaras, Andrea Garcia, Kasey Hamlin-Smith, Michelle Harwood Berkowits, Sylvia Fajardo-Hiriart, Elaine E Mathews, Helina Pierre, Arielle Riguard, Alexandra Stroerger, Kristi L Watterberg, Robin K Ohls, Janell Fuller, Conra Backstrom Lacy, Jean Lowe, Rebecca Montman, Dale L Phelps, Gary J Myers, Gary David Markowitz, Linda J Reubens, Diane Hust, Julie Babish Johnson, Erica Burnell, Rosemary L Jensen, Emily Kushner, Joan Merzbach, Kelley Yost, Pablo J Sánchez, Charles R Rosenfeld, Walid A Salhab, Roy J Heyne, Luc P Brion, Sally S Adams, James Allen, Laura Grau, Alicia Guzman, Gaynelle Hensley, Elizabeth T Heyne, Melissa H Leps, Linda A Madden, Melissa Swensen Martin, Nancy A Miller, Janet S Morgan, Araceli Solis, Lizette E Torres, Catherine Twell Boatman, Diana M Vasil, Kathleen A Kennedy, Jon E Tyson, Nora I Alaniz, Patricia W Evans, Beverly Foley Harris, Charles Green, Margarita Jiminez, Anna E Lis, Sarah Martin, Georgia E McDavid, Brenda H Morris, Margaret L Poundstone, Stacy Reddoch, Saba Siddiki, Patti L Pierce Tate, Laura L Whitely, Sharon L Wright, Roger G Faix, Bradley A Yoder, Shawna Baker, Karie Bird, Jill Burnett, Karen A Osborne, Cynthia Spencer, Michael Steffen, Kimberlee Weaver-Lewis, T Michael O'Shea, Robert G Dillard, Lisa K Washburn, Nancy J Peters, Barbara G Jackson, Korinne Chiu, Deborah Evans Allred, Donald J Goldstein, Raquel Halfond, Carroll Peterson, Ellen L Waldrep, Cherrie D Welch, Melissa Whalen Morris, Gail Wiley Hounshell, Seetha Shankaran, Beena G Sood, Athina Pappas, Rebecca Bara, Laura A Goldston, Mary E Johnson, Richard A Ehrenkranz, Vineet Bhandari, Harris C Jacobs, Pat Cervone, Patricia Gettner, Monica Konstantino, JoAnn Poulsen, Janet Taft, Christine G Butler, Nancy Close, Walter Gilliam, Sheila Greisman, Elaine Romano, Joanne Williams
Abstract
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.
Keywords: Intensive Care; Mortality; Neonatology; Neurodisability; Respiratory.
Conflict of interest statement
Conflicts of interest: The authors have no conflicts of interest relevant to this article to disclose.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Source: PubMed