Use of Continuous Positive Airway Pressure in the Improved Postoperative Management of Neonatal Respiratory Emergencies

Abstract

In newborns with hyaline membrane disease, spontaneous breathing with continuous positive airway pressure (Gregory technique) has dramatically decreased the mortality. We have applied this technique in the postoperative management of cardiac and noncardiac thoracic emergencies in more than 13 low-weight infants (2 to 6 kg.) from 12 hours to 6 months old. This type of ventilatory support raises the intraalveolar pressure throughout the respiratory cycle and appears to prevent lobular and segmental atelectasis. The physiological effect is to increase Pa o 2 by decreasing intrapulmonary shunting and improving the ventilation-perfusion abnormalities, possibly by changing the relationship of interstitial fluid to the respiratory membrane. This technique allowed us to eliminate the hazardous use of mechanical ventilators in these tiny infants.