1 Department of Pediatrics, Pathology and Radiology, University of Manitoba, Winnipeg
Review of 158 patients with hyaline membrane disease was undertaken. The introduction of artificial ventilation with a positive end-expiratory pressure (IPPB and PEEP) has doubled the prevalence of pneumothorax, pneumomediastinum and interstitial emphysema from 20.7% to 39.7%). Continuous negative distending pressure during spontaneous ventilation (CNP) was associated with a prevalence of lung rupture similar to that occurring spontaneously (4.8%). No patient treated with CNP alone developed bronchopulmonary dysplasia. Patients treated with IPPB with PEEP had a marked decreased prevalence of bronchopulmonary dysplasia (17.2%) when compared to patients treated with IPPB alone (36.2%), probably related to the enhanced ability to rapidly reduce inspired oxygen concentrations. It is postulated that unequal time constants with subsequent overdistension of relatively normal areas of the lung may be related to the increased prevalence of lung rupture seen during IPPB with PEEP.
Submitted on October 23, 1973