Is Continuous Transpulmonary Pressure Better Than Conventional Respiratory Management of Hyaline Membrane Disease? A Controlled Study

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Abstract
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 [O2 tension] was .ltoreq. 50 mm Hg with FiO2 [fractional concentration of O2 in inspired gas] .gtoreq. 0.6. Patients [24] in each of 3 weight groups were equally divided between treatment and control groups. The treatment regimen included CPAP (6-14 cm H2O) for spontaneously breathing patients and PEEP for patients requiring mechanical ventilation for apnea of hypercapnia (PCO2 [CO2 tension] .gtoreq. 65 mm Hg). Control patients received O2 and were mechanically ventilated if they had apnea, hypercapnia or PO2 .ltoreq. 50 mmHg with FiO2 .gtoreq. 0.8. Oxygenation improved after the start of CPAP or PEEP; 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. CPAP and PEEP apparently have not significantly altered the outcome of HMD.

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