Use of permissive hypercapnia in the ventilation of infants with respiratory syncytial virus infection

We wished to retrospectively evaluate the effects of permissive hypercapnia (PHY) on barotrauma, mortality and length of stay when applied to ventilat ed infants with respiratory syncytial virus (RSV) bronchiolitis. Nineteen c ontrol infants with RSV induced respiratory failure were treated with conve ntional ventilation (April 1991-January 1994), after which time PHY was ado pted as unit policy. A further 28 infants were then treated with PHY (Janua ry 1994-April 1996). Demographic and physiological data were collected from admission, and outcome Variables including length of stay, barotrauma and mortality were recorded. The PHY group showed a significantly higher mean p CO(2) (7.6 vs 5.2 kPa), a lower mean pH (7.34 vs 7.40), and a reduction in maximal peak inspiratory pressures (25 vs 30 cmH(2)O). Mortality, barotraum a, use of neuromuscular blockade and nosocomial infection did not differ be tween groups. There was a trend towards increased length of ventilation in the PHY group (median 7 vs 5 days). Conclusion Based on this retrospective data we can show no benefit for the use of permissive hypercapnia as a ventilatory strategy in this patient gro up. A prospective randomised controlled trial is warranted to accurately as sess the outcome variables and cost implications of this strategy.