Distending pressure in infants with respiratory distress syndrome.

The application of distending pressure to 40 babies with the respiratory distress syndrome (RDS) is described. Pressures greater than 10 cm H2O were rarely used. On starting distending pressure, considerable improvements in blood gases occurred in all but 4 babies, 2 of whom had pneumothoraces and the other rapidly deteriorated and died from an intraventricular haemorrhage shortly afterwards. In 27 babies the distending pressure was applied for hypoxaemia during the course of the disease. 16 survived without further intervention, though one case eventually required long-term continuous distending pressure (CDP) for pulmonary oedema. 11 out of the 27 required intermittent positive pressure ventilation (IPPV), with 6 survivors. In 13 other babies who had not received CDP previously, the technique was used to assist weaning from IPPV. It sustained oxygenation in each case, and 12 of these babies survived. Seven babies developed pneumothoraces and 2 babies intrapulmonary cysts. 6 babies died, 3 with pneumothoraces. The overall incidence of intraventricular haemorrhage was 3 proven and 2 suspected cases. There was no evidence that distending pressure in any form increased the incidence of intracranial haemorrhage.