Simplified Mechanical Ventilation for Hyaline-Membrane Disease

Blake, A M; Durbin, G M; Macnab, Andrew; Collins, Lindsey M.; Hunter, Nahla; Reynolds, Eor; Sellens, G

doi:10.1016/s0140-6736(73)92941-3

Cited by 26 publications

(11 citation statements)

References 10 publications

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“…The ventilators used were Draeger Spiromat 661 or Bourns BP-200 machines. The management of the infants during mechanical ventilation was as previously described (Blake et al, 1973;Reynolds, 1975;Allen et al, 1975;Durbin et al, 1976). For mask ventilation the initial settings were as follows: peak airway pressure 0-12 kPa (12 cm H5O), endexpiratory pressure 0-02 kPa (2 cm H5O), respiratory frequency 36 cycles per minute, inspiration: expiration ratio 1:2 or 1:1.…”

Section: Resultsmentioning

confidence: 99%

Controlled trial of continuous positive airway pressure given by face mask for hyaline membrane disease.

Allen¹,

Reynolds²,

Rivers³

et al. 1977

Archives of Disease in Childhood

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SUMMARY A controlled trial of elective intervention with continuous positive airway pressure (CPAP) was performed on 24 infants with hyaline membrane disease whose arterial oxygen tension (Pao2) fell below 8 kPa (60 mmHg) while they were breathing a fractional inspired oxygen concentration (F,o2) greater than 0 60. A face mask was used to apply the CPAP. The progress of the 12 infants who were treated on entry to the trial was compared with that of 12 infants who were treated later. All 12 infants in the early-intervention group and 8 infants in the late-intervention group survived. When CPAP was started, Pao2 increased and the early-treated infants breathed high concentrations of oxygen for a shorter period than the late-treated infants. The 4 infants in the earlyintervention group who required mechanical ventilation needed lower mean airway pressures to achieve satisfactory gas exchange than the 7 ventilated infants in the late-intervention group. We conclude that a Pao2 < 8 kPa while breathing an FIO2 >0 60 is an adequate indication for giving CPAP in hyaline membrane disease, and that early intervention with CPAP allows infants who go on to require mechanical ventilation to be ventilated at lower pressures.All who have used continuous positive airway pressure (CPAP) for treating hyaline membrane disease agree that it effectively improves arterial oxygen tension (Pao2) and reduces the infant's need for a high inspired oxygen concentration (Fio,) (Gregory et al

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Section: Resultsmentioning

confidence: 99%

Controlled trial of continuous positive airway pressure given by face mask for hyaline membrane disease.

Allen¹,

Reynolds²,

Rivers³

et al. 1977

Archives of Disease in Childhood

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“…for the early follicular phase.9 LH and FSH release after LH-RH were either normal or exaggerated when compared with the responses of normal women in the early follicular phase. 9 After administration of the oestradiol benzoate circulating levels of FSH, and LH in most cases, were initially suppressed in all patients. Only one patient (case 14) responded normally as defined by an increase in LH 72 hours after the oestradiol benzoate (see fig.).…”

Section: Introductionmentioning

confidence: 90%

“…A positive response was defined as an increase in LH of 8 U/I and in FSH of 3 U/I above mean baseline values within 96 hours.8 The gonadotrophin release in response to LH-RH was assessed in all patients after injection of 100 isg LH-RH (Hoechst Pharmaceuticals) as previously described. 9 Hormone Measurements.-Serum LH, FSH, oestradiol, and progesterone were estimated using specific radioimmunoassays (R.I.A. ).9 Serum prolactin was measured by a double antibody R.I.A.…”

Section: Introductionmentioning

confidence: 99%

Prognosis for infants with idiopathic respiratory distress syndrome.

Robertson¹,

Tizard²

1975

BMJ

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“…Mechanical ventilation was started when the Pao2 fell below 35 mmHg or if the infant seemed likely to collapse, as judged by the presence of peripheral vasoconstriction, gasps, a slowing respiratory rate, or a slowing heart rate. A Draeger Spiromat 661 or 662 ventilator was used as previously described (Blake et al, 1973;Reynolds, 1975).…”

Section: Methodsmentioning

confidence: 99%

“…We have used very high concentrations of oxygen-up to an FIo2 of 1 00 if necessary-in the management of infants with HMD before contemplating ventilatory support, and have used mechanical ventilator techniques which minimized trauma to the lung if the infant could not sustain adequate gas exchange (Herman and Reynolds, 1973;Blake et al, 1973;Reynolds, 1974). Because we were uncertain whether elective intervention with CIP had any advantages over our previous methods of management, a controlled trial has been carried out, the results of which are reported here.…”

mentioning

confidence: 99%

Controlled trial of continuous inflating pressure for hyaline membrane disease.

Durbin¹,

Hunter²,

McIntosh³

et al. 1976

Archives of Disease in Childhood

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was performed in infants with severe hyaline membrane disease who weighed more than 1000 g at birth. Infants entered the trial if their arterial oxygen tension (PaoQ) fell below 60 mmHg while breathing a fractional inspired oxygen concentration (FIo,) greater than 095. 11 out of 12 infants in the CIP-treated group and 10 out of 12 in the control group survived. 7 treated and 6 control infants required mechanical ventilation. When CIP was started the Pao, of the treated infants increased, and they breathed high concentrations of oxygen for a significantly shorter period than the control infants. During the 31-month duration of the trial 107 other infants with severe hyaline membrane disease were admitted who did not meet the criteria for entry to the trial. 37 survived after breathing high concentrations of oxygen (FIO2 >0 * 60) spontaneously without any ventilatory assistance, and the remaining 70 infants were already being ventilated on their arrival in the unit, usually because they had required mechanical ventilation during transfer from other hospitals. The neonatal survival rate for those infants born in this hospital during the study period was 88% (50 out of 57 infants) and for those referred from other hospitals it was 69% (51 out of 74 infants). The maximum further increase in overall survival rate that might have been achieved in our population of infants if CIP had been initiated very early in the course of the illness was 5 %-i.e. from 77% (101/131) to 82% (107/131).In 1971, Gregory et al. published their important study showing that if infants with hyaline membrane disease (HMD) breathed spontaneously against a continuous positive airway pressure (CPAP) applied down an endotracheal tube or from a pressurized head-box, lung inflation improved and arterial oxygen tension (Pao,) increased. Since then various methods for applying CPAP have been devised, using a face mask (Rhodes and Hall, 1973), a plastic bag over the head (Barrie, 1973), and nasal cannulae (Kattwinkel et al., 1973;Caliumi-Pellegrini et al., 1974). Other authors (Chernick, and Vidyasagar, 1972)

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Simplified Mechanical Ventilation for Hyaline-Membrane Disease

Cited by 26 publications

References 10 publications

Controlled trial of continuous positive airway pressure given by face mask for hyaline membrane disease.

Controlled trial of continuous positive airway pressure given by face mask for hyaline membrane disease.

Prognosis for infants with idiopathic respiratory distress syndrome.

Controlled trial of continuous inflating pressure for hyaline membrane disease.

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