CDP: a major breakthrough!
Wung, J.T.; Stark, R.I.; Hegyi, T.; Driscoll, J.M.; James, L.S.
Pediatrics 58(6): 783-787
1976
ISSN/ISBN: 0031-4005 PMID: 792788 Document Number: 107240
Five years ago the use of continuous positive airway pressure (CPAP) was introduced to augment the treatment of RDS may be due to several effects. These include an increase in the functional residual capacity which is low in infants with RDS; the improvement in arterial O2 tension observed in all studies indicates an improvement in the ventilation-to-perfusion ratio. A reduction in the incidence of apnea with CDP suggests that the respiratory drive is increased, possibly mediated through the Hering-Breuer reflex. Other investigations point to a sparing effect on surfactant and the ratio of lecithin to sphingomyelin in tracheal fluid increases earlier in the course of RDS when treatment with CDP is initiated. CDP may act to produce both beneficial and detrimental effects: if optimal pressure for that particular patient is exceeded, alveoli may be overdistended, decreasing compliance and eventually causing air leak; venous return may also be obstructed leading to a decrease in cardiac output. The need is stressed for special training and experience in every aspect of assisted ventilation and neonatal intensive care if optimal outcome is to be attained.