Permissive Hypercapnia

  • Patrick Hassett
  • John G. Laffey
  • Brian P. KavanaghEmail author


The potential for high stretch mechanical ventilation to cause ventilator induced lung injury (VILI) and worsen the severity of ARDS is clear. Protective ventilatory strategies that reduce tidal and minute ventilation improve outcome in children with severely injured lungs. The high levels of PaCO2 arising from restrictive ventilation are well tolerated clinically and have been termed ‘Permissive Hypercapnia’. The benefits of ventilatory strategies incorporating permissive hypercapnia are assumed to be a result of reduced lung stretch. However hypercapnia itself has the potential to exert a multitude of beneficial – and harmful – effects, and should not be thought of as a mere ‘bystander’.

This chapter will focus on ventilator strategies involving permissive hypercapnia in neonates and infants with acute respiratory failure. Using evidence gathered from laboratory studies, we will examine the biological effects of hypercapnia on organ systems and the modulating effects that hypercapnia has on systemic and lung injury models. The evidence that hypercapnia may exert direct effects on the severity of lung injury will be considered. The role of permissive hypercapnia in a variety of clinical settings of relevance to neonatal and paediatric practice will then be discussed. Finally the risks and benefits of permissive hypercapnia will be considered in specific clinical situations.


Lung Injury Pulmonary Vascular Resistance Hypoplastic Left Heart Syndrome Congenital Diaphragmatic Hernia Ventilator Induce Lung Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Patrick Hassett
    • 1
    • 2
  • John G. Laffey
    • 3
  • Brian P. Kavanagh
    • 4
    Email author
  1. 1.Lung Biology GroupNational Centre of Biomedical Engineering Sciences, National University of Ireland, GalwayGalwayIreland
  2. 2.Department of Anaesthesia and Intensive Care MedicineUniversity College HospitalGalwayIreland
  3. 3.Department of Anesthesia, Keenan Research Centre for Biomedical ScienceSt. Michael’s Hospital, University of TorontoTorontoCanada
  4. 4.Departments of Critical Care Medicine and Anesthesia and the Program in Physiology and Experimental Medicine and the Program in Physiology and Experimental MedicineHospital for Sick Children, University of TorontoTorontoCanada

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