The effect of continuous positive airway pressure on the course of respiratory distress syndrome: the benefits on early initiation. The early use of continuous positive airway pressure in the treatment of idiopathic respiratory distress syndrome. Early versus delayed initiation of continuous negative pressure in infants with hyaline membrane disease.
The course of idiopathic respiratory distress syndrome (IRDS) treated with continuous positive airway pressure (CPAP) was studied in 38 infants with a respiratory index (RI) based on AaDO2 and PO2 measurements. Thirteen infants were treated with early CPAP (FIO2 = 0.3, PO2 greater than 50 torr (6.7k Pa) at a mean age of 7.1 h and 25 infants received late CPAP (FIO2 = 0.5, PO2 greater than 50 torr) at a mean age of 15.1 h. Significant differences were demonstrated between the two groups in duration of CPAP (42 versus 72 hours) peak RI (3.7 vs. 6.7), time to peak RI from start of therapy (10.0 versus 19.4 h), number of infants ventilated (0 versus 5) and number of air leaks (0 versus 3). The rate of disease worsening as measured by changes in RI/h before CPAP and after CPAP initiation was comparable in the respective treatment groups. Infants with IRDS were treated with CPAP early (0.40 FIO2; WITH PaO2 less than 60 mm Hg) or late (0.70 FIO2; with PaO2 less than 60 mm Hg). There was no difference in survival, duration of CPAP therapy, total time of oxygen administration, or complications. The early treated infants needed a lower FIO2 (maximum 0.55) and had a less severe clinical course. The late treated infants were subjected to 0.70 or more FIO2 for an average of 24 hours and were in greater than 0.40 FIO2 significantly longer than those given CPAP early. Infants who weighed less than 1,500 gm and had severe disease did not do well regardless of when CPAP was applied. Twenty-three infants with HMD of similar severity, who were less than 24 hours of age and who were breathing spontaneously, were divided by random numbers into early and delayed CNP groups. The infants who were treated with CNP before their PaO2 was less than 50 mm Hg while breathing 70% oxygen experienced a significantly greater increase in PaO2 in response to the initiation of CNP, required less time with O2 therapy, required no mechanical ventilation, and had fewer complications. Based on these results, it is suggested that CNP be initiated in infants with HMD, who are less than 24 hours of age and are breathing spontaneously, before the PaO2 becomes less than 50 mm Hg on 70% O2.
Early application of CDP has a clinical benefit in the treatment of RDS in that it reduces subsequent use of IPPV and thus may be useful in preventing the adverse effects of this treatment. However, many of the trials were done in the 1970s and 1980s and re-evaluation of the strategy of early CDP in the era of antenatal steroid use and early surfactant administration is indicated focusing on administration methods.