Mechanical ventilation of infants with severe hyaline membrane disease in a regional newborn intensive care unit.

Abstract

Thirty (86%) of 35 Infants with birthwelghts >1000 g survived mechanical ventilation for severe hyaline membrane disease. There were no deaths In infants with birthweights >1500 g or gestational ages ≥31 wk. Most Infants could be ventilated satisfactorlly with intermittent mandatory ventilation using square pressure waveform, low peak airway pressure, positive end-expiratory pressure, low ventilator frequency and an inspiratory: expiratory time ratio <1:1. Seven Infants who were hypoxaemic despite a high fractional inspired oxygen and a peak airway pressure ≥ 25 cm of water showed a sustained improvement in oxygenatiort following muscle relaxation with d-tubocurarine, acute blood volume expansion and isoprenaline Infusion. Xanthine derivatives were used to facilitate weaning from mechanical ventilation In 37% of infants. Although overall survival of outborn Infants was not significantly different from that of inborn Infants, survival was less common in outborn infants from 27 to 30 weeks gestation. In addition, severe perinatal asphyxia and mechanical ventilation for cardiopulmonary collapse were more common In outborn infants. Fifty percent of outborn infants required mechanical ventilation during transport.