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 Vol. 8 No. 8, August 2007
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NeoReviews Vol.8 No.8 2007 e345
© 2007 American Academy of Pediatrics

Permissive Hypercapnia in Neonates

J. Davin Miller, MD*
Waldemar A. Carlo, MD*

* Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Ala

Permissive hypercapnia, involving the acceptance of higher values of arterial CO2 tension (PaCO2) while using lower tidal volumes, may reduce the risk of lung injury. Animal models and in vitro experimental data suggest that hypercapnia may enhance host defense mechanisms in preterm lungs through anti-inflammatory and immune-modulating mechanisms. Retrospective studies in neonates have documented the association of higher PaCO2 with less lung injury. Randomized clinical trials have shown a decreased need for assisted ventilation and a trend toward a lower incidence of bronchopulmonary dysplasia or death with permissive hypercapnia. Continued research is needed to determine the appropriate clinical application of permissive hypercapnia, the optimal level of hypercapnic acidosis, and the safety of the therapy in preterm infants.


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Copyright © 2007 by the American Academy of Pediatrics.