Elsevier

The Journal of Pediatrics

Volume 91, Issue 3, September 1977, Pages 449-454
The Journal of Pediatrics

Determination of optimal continuous positive airway pressure for the treatment of IRDS by measurement of esophageal pressure

https://doi.org/10.1016/S0022-3476(77)81323-1Get rights and content

We describe a simple and reliable method to determine optimal airway pressure in infants with idiopathic respiratory distress syndrome who require continuous positive airway pressure treatment. Esophageal pressure was monitored in ten infants with IRDS during initial application of CPAP. As the level of CPAP was increased in 2 cm H2O increments, changes in Pes were compared with changes in PaO2 Below optimal airway pressure, Pes as well as PaO2 increased insignificantly. When optimal airway pressure (8.1±0.8 cm H2O) was applied, there was a marked increase in Pes (3.6±0.8 cm H2O p<0.001) and PaO2 (39.0±10.0 mm Hg, p<0.01). Further increase in CPAP did not result in any subsequent appreciable increase in Pes while PaO2 decreased slightly and PaCO2 increased. Less than optimal CPAP increases FIO2 requirements and may increase the associated risk of bronchopulmonary dysplasia, while excessive levels of CPAP may increase the risk of pneumothorax. We suggest that esophageal pressure be monitored routinely to determine the optimal level of CPAP for each infant during the initial application of therapy.

References (25)

  • KarlbergP et al.

    Studies of respiratory physiology in the newborn infant: Observations during and after respiratory distress

    Acta Paediatr

    (1954)
  • LauwerynsJM et al.

    The pulmonary lymphatics in neonatal hyaline membrane disease

    Pediatrics

    (1968)
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    Supported by Grant RR-125 GCRC Branch, Division of Research Resources, National Institutes of Health

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