Individualised continuous distending pressure applied within 6 hours of delivery in infants with respiratory distress syndrome.

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Abstract
A preliminary study was performed in which a simple clinical technique for estimating appropriate levels of continuous distending pressure (CDP) in infants with respiratory distress syndrome (RDS) was used to compare 2 groups of infants; 1 group had CDP started very early in life (3.1 .+-. 0.3 h) while in the other treatment was started at a more conventional age (23 .+-. 5.4 h). Appropriate CDP was identified as the point at which transpulmonary transmission of airways pressure to the esophagus suddenly increased while serial measurements allowed CDP levels to be instituted and varied according to physiological signs during the course of each infant''s disease. O2 requirements fell to < 35% more rapidly in the early-treated group (10.6 .+-. 1.2 vs. 67.4 .+-. 5.6 h; P < 0.001), as did the requirement for a CDP > 4 cmH2O (28.9 .+-. 5.3 vs. 87.6 .+-. 14.2 h; P < 0.01). Better (P < 0.01) values for pH, PaCO2 [arterial CO2 pressure] and A-aDO2 [alveolar-arterial O2 diffusion] were observed in the early-treated group. This simple technique has numerous advantages. Very early introduction of CDP can be realized in a manner selective enough for it to be used only in those infants in whom intervention is justified.