Acute pulmonary X-ray changes in hyaline membrane disease treated with artificial ventilation and positive end-expiratory pressure (PEP)

Abstract

A retrospective radiological study of 35 babies with hyaline membrane disease (HMD) is presented. There were twelve out of 19 cases who had adequate pre-PEP-films and who were radiologically in Stage IV or Stage III initially: these twelve infants showed a spectacular improvement to Stage II or Stage I within 24 hours. Although there was, in general, a good correlation between radiological and clinical/biochemical improvement, these parameters did, on occasion, diverge completely. Following the introduction of PEP ventilation there has been a dramatic fall in mortality from 56% to 26%. Fourteen out of 35 cases showed interstitial emphyscma. Eight out of 35 cases had mediastinal emphysema of some degree. Pneumothorax occurred in 10 of the 35 infants and pneumopericardium occurred in 3 of the 35 infants. These complications are clinically the most important but they can be treated successfully without discontinuing PEP ventilation. Alveolar ventilation is only one link in the chain which ensures adequate oxygenation of the blood. However, anoxia secondary to alveolar collapse has ceased to be, in our experience, a cause of death in hyaline membrane disease.