A preliminary study was performed in which a simple clinical technique for estimating appropriate levels of continuous distending pressure (CDP) in infants with respiratory distress syndrome (RDS) was used to compare two groups of infants; one group had CDP started very early in life (3.1 +/- 0.3 hours) while in the other treatment was started at a more conventional age (23 +/- 5.4 hours). Appropriate CDP was identified as the point at which transpulmonary transmission of airways pressure to the oesophagus was seen suddenly to increase, while serial measurements allowed CDP levels to be instituted and varied according to physiological signs during the course of each infant's disease. Oxygen requirements fell to less than 35% more rapidly in the early-treated group (10.6 +/- 1.2 v. 67.4 +/- 5.6 hours; P less than 0.001), as did the requirement for a CDP greater than 4 cmH2O (28.9 +/- 5.3 v. 87.6 +/- 14.2 hours; P less than 0.001). Better (P less than 0.01) values for pH, PaCO2, and A-aDO2 were observed in the early-treated group. We believe that the use of this simple technique has numerous advantages and that very early introduction of CDP can be realised in a manner selective enought for it to be used in those infants in whom intervention is justified.
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