Is Continuous Transpulmonary Pressure Better Than Conventional Respiratory Management of Hyaline Membrane Disease?
David A. Belenky M.D.1, Rosemary J. Orr M.B., B.Ch., D.C.H.1, David E. Woodrum M.D.1, , 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 50 mm Hg with FiO2 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 65 mm Hg). Control patients received oxygen and were mechanically ventilated if they had apnea, hypercapnia, or PO2 50 mm Hg with FiO2 0.8. Oxygenation improved after the start of CPAP or
