PEDIATRICS Vol. 58 No. 6 December 1976, pp. 800-808
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Is Continuous Transpulmonary Pressure Better Than Conventional Respiratory Management of Hyaline Membrane Disease? A Controlled Study

David A. Belenky M.D.1, Rosemary J. Orr M.B., B.Ch., D.C.H.1, David E. Woodrum M.D.1, and W. Alan Hodson M.D.1

1 Division of Neonatal Biology, Department of Pediatrics, University of Washington School of Medicine, Seattle

The influence of continuous positive airway pressure (CPAP) and positive end-expiratory pressure (PEEP) on mortality and complication rates in severe hyaline membrane disease (HMD) was evaluated in a randomized, prospective study. Patients were admitted to the study if the PO2 was le 50 mm Hg with FiO2 ge 0.6. Twenty-four patients in each of three weight groups were equally divided between treatment and control groups. The treatment regimen included CPAP (6 to 14 cm H2O) for spontaneously breathing patients and PEEP for patients requiring mechanical ventilation for apnea or hypercapnia (PCO2 ge 65 mm Hg). Control patients received oxygen and were mechanically ventilated if they had apnea, hypercapnia, or PO2 le 50 mm Hg with FiO2 ge 0.8. Oxygenation improved after the start of CPAP or PEEP; however, PCO2 rose after CPAP was initiated. There was no significant difference between treatment and control groups in mortality, requirement for mechanical ventilation, or incidence of pulmonary sequelae. The incidence of pulmonary air-leak was increased with PEEP. The findings suggest that CPAP and PEEP have not significantly altered the outcome of HMD.

Submitted on December 29, 1975
Accepted on June 16, 1976