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Is continuous transpulmonary pressure better than conventional respiratory management of hyaline membrane disease? A controlled study
Belenky DA, Orr RJ, Woodrum DE, Hodson WA
Pediatrics 1976 Dec;58(6):800-808
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

The influence of continuous positive airway pressure (CPAP) and positive end-expiratory pressure (PEEP) on mortality and complication rates in severe hyaline membrane disease (HMD) was evaluated in a randomized, prospective study. Patients were admitted to the study if the PO2 was less than 50 mmHg with FiO2 greater than 0.6. Twenty-four patients in each of three weight groups were equally divided between treatment and control groups. The treatment regimen included CPAP (6 to 14 cmH2O) for spontaneously breathing patients and PEEP for patients requiring mechanical ventilation for apnea or hypercapnia (PCO2 > 65 mmHg). Control patients received oxygen and were mechanically ventilated if they had apnea, hypercapnia, or PO2 less than 50 mmHg with FiO2 greater than 0.8. Oxygenation improved after the start of CPAP or PEEP; however, PCO2 rose after CPAP was initiated. There was no significant difference between treatment and control groups in mortality, requirement for mechanical ventilation, or incidence of pulmonary sequelae. The incidence of pulmonary air-leak was increased with PEEP. the findings suggest that CPAP and PEEP have not significantly altered the outcome of HMD.
Reproduced with permission from Pediatrics. Copyright by the American Academy of Pediatrics.

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