I have never used temp corrected gas to guide my ventilation but I have never

Regarding the accuracy of using temperature-corrected arterial partial pressure of carbon dioxide (PaCO) in infants cooled for hypoxic-ischemic encephalopathy (HIE), the provided NICE guidelines lack specific direct recommendations or evidence addressing the use of temperature-corrected PaCO for more accurate assessment during therapeutic hypothermia.NICE NG124 Similarly, the referenced literature on therapeutic hypothermia in HIE primarily focuses on cooling strategies, neurodevelopmental outcomes, and transport methods rather than the biochemical monitoring of PaCO specifically Jacobs et al. 2013Sibrecht et al. 2023.

However, known physiological principles from hypothermia management infer that hypothermia reduces metabolic rate and can affect blood gas solubility and measurements, thus temperature correction of arterial blood gases including PaCO is often used to better estimate the true in vivo values under hypothermia conditions.NICE NG124 Nevertheless, actively targeting a "normocapnic" PaCO corrected to the lower hypothermic body temperature may risk overventilation because the corrected PaCO is lower than the uncorrected (ambient temperature) measurement.

Potential risks of targeting a normal "temperature-corrected" PaCO include: overventilation leading to hypocapnia, which can cause cerebral vasoconstriction, thereby reducing cerebral blood flow and potentially exacerbating brain injury in vulnerable infants with HIE.NICE NG124 These adverse effects highlight the need for cautious ventilation management aiming to avoid excessive lowering of PaCO, which could worsen cerebral ischemia despite normocapnia by temperature correction.

In summary, while temperature correction of PaCO provides a theoretically more accurate reflection of in vivo arterial blood gases during hypothermia, it carries the risk of overventilation and resultant cerebral vasoconstriction and reduced cerebral perfusion if ventilation is adjusted solely to the corrected values without consideration of the clinical context and other monitoring parameters.NICE NG124 The evidence specifically for infants cooled for HIE remains limited, and this approach should be balanced with close clinical and multimodal monitoring to optimize ventilation management during therapeutic hypothermia.