All infants in our center with severe respiratory distress syndrome who have required artificial ventilation with 80–100 % O2 for more than 5 days have shown abnormalities in the lungs with characteristic radiologic findings and prolonged hypercarbia following extubation. Microscopic examination of lung sections of 13 infants who died revealed hypertrophic bronchial mucosal glands and necrotic bronchial epithelium blocking some of the fine airways. The known tendency of the small airways of an infant to collapse and the microscopic appearance of the lung suggested that after extubation vigorous pulmonary drainage might be of value. To prevent this complication rapid graded weaning from the ventilator is now attempted and following extubation, postural drainage, chest percussion, vibration, and tracheal suction under direct vision are performed at first hourly, decreasing to daily intervals by the third day.
8 infants (1700–2020 g) maintained on a respirator for 5 to 17 days but not receiving intensive pulmonary physiotherapy, still had evidence of pulmonary disease 2–18 months after extubation. 3 infants (1700–2500 g) who received intensive pulmonary drainage after being on the respirator for 2 ½, 6 ½, 7 ½ days had no apparent pulmonary disease 18, 27, 30 days after extubation. 6 infants (860–4000 gm) with respiratory failure associated with other diseases who were maintained on a ventilator for 1–2 days and who were also treated with intensive suctioning following extubation, recovered promptly. These observations suggest that some of the complications of prolonged artificial ventilation with high O2 concentrations may be preventable. (SPR)
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Cave, P., Northway, W., Klaus, M. et al. 85 A Treatment for the Complications of Prolonged Artificial Ventilation of Small Infants. Pediatr Res 1, 222 (1967). https://doi.org/10.1203/00006450-196705000-00092
New England Journal of Medicine (1968)