Continuous distending pressure for respiratory distress in preterm infants

  • Review
  • Intervention




Respiratory distress syndrome (RDS) is the single most important cause of morbidity and mortality in preterm infants (Greenough 1998, Bancalari 1992). Intermittent positive pressure ventilation (IPPV) with surfactant is the standard treatment for the condition. The major difficulty with IPPV is that it is invasive, resulting in airway and lung injury and contributing to the development of chronic lung disease.


To determine the effect of continuous distending pressure (CDP) on the need for IPPV and associated morbidity in spontaneously breathing preterm infants with respiratory distress.

Search methods

The standard search strategy of the Neonatal Review Group was used. This included searches of the Oxford Database of Perinatal Trials, Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 2, 2008), MEDLINE (1966 - February, 2008), and EMBASE (1980 - February 2008), previous reviews including cross references, abstracts, conference and symposia proceedings, expert informants, journal hand searching mainly in the English language.

Selection criteria

All trials using random or quasi-random allocation of preterm infants with respiratory distress were eligible. Interventions were continuous distending pressure including continuous positive airway pressure (CPAP) by mask, nasal prong, nasopharyngeal tube, or endotracheal tube, or continuous negative pressure (CNP) via a chamber enclosing the thorax and lower body, compared with standard care.

Data collection and analysis

Standard methods of the Cochrane Collaboration and its Neonatal Review Group were used, including independent assessment of trial quality and extraction of data by each author.

Main results

CDP is associated with a lower rate of failed treatment (death or use of assisted ventilation) [summary RR 0.65 (95% CI 0.52, 0.81), RD -0.20 (95% CI -0.29, -0.10), NNT 5 (95% CI 4, 10)], overall mortality [summary RR 0.52 (95% CI 0.32, 0.87), RD -0.15 (95% CI -0.26, -0.04), NNT 7 (95% CI 4, 25)], and mortality in infants with birth weights above 1500 g [summary RR 0.24 (95% CI 0.07, 0.84), RD -0.28 (95% CI -0.48, -0.08), NNT 4 (95% CI 2, 13)]. The use of CDP is associated with an increased rate of pneumothorax [summary RR 2.64 (95% CI 1.39, 5.04), RD 0.10 (95% CI 0.04, 0.17), NNH 17 (95% CI 17, 25)].

Authors' conclusions

In preterm infants with respiratory distress the application of CDP either as CPAP or CNP is associated with reduced respiratory failure and reduced mortality. CDP is associated with an increased rate of pneumothorax. Four out of six of these trials were done in the 1970's. Therefore, the applicability of these results to current practice is difficult to assess. Where resources are limited, such as in developing countries, CPAP for RDS may have a clinical role. Further research is required to determine the best mode of administration and the role of CDP in modern intensive care settings




呼吸窘迫症候群(RDS)是早產兒疾病與死亡的最重要單一原因(Greenough 1998, Bancalari 1992)。應用表面活性劑進行間歇正壓通氣(IPPV)是該病的標準治療法。 IPPV的主要困難是由於其侵入性,導致呼吸道和肺損傷,引發慢性肺部疾病。










CDP與治療失敗率降低(死亡或使用輔助通氣)[總RR 0.70 (0.55, 0.88), RD −0.22 (−0.35, −0.09), NNT 5 (3, 11)],總死亡率[總RR 0.52 (0.32, 0.87), RD −0.15 (−0.26, −0.04), NNT 7 (4, 25)],以及出生體重大於1500克嬰兒的死亡率降低[總RR 0.24 (0.07, 0.84), RD −0.281 (−0.483, −0.078), NNT 4 (2, 13)]有關聯。 CDP的使用與氣胸發病率增加[總RR 2.36 (1.25, 5.54), RD 0.14 (0.04, 0.23), NNH 7 (4, 24)]也有關聯。





此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。


利用持續擴張壓(CDP)治療早產嬰兒的呼吸窘迫症候群被發現是有益處的。呼吸窘迫症候群(RDS)是在34週前出生的嬰兒最常見的疾病和造成死亡的原因。間歇正壓通氣(IPPV)是幫助這些嬰兒呼吸標準的方式。一個協助呼吸簡單的方法,是在胸外提供持續肺擴張的壓力  無論是持續氣道正壓或連續負壓(部分真空)。在本試驗回顧發現,持續擴張壓(CDP)可降低死亡率或需要輔助通氣,需要IPPV的機會。過去一些小型的試驗也發現,CDP有不利的影響是會增加氣胸機率(空氣在胸腔內,肺以外地方)。

Plain language summary

Continuous distending pressure for respiratory distress in preterm infants

Some benefits found in using continuous distending pressure (CDP) for respiratory distress syndrome in preterm babies.

Respiratory distress syndrome (RDS) is the most common cause of disease and death in babies born before 34 weeks gestation. Intermittent positive pressure ventilation (IPPV) is the standard way of helping these babies breathe. A simpler method of assisting breathing is to provide a continuous lung distending pressure - either no continuous positive pressure to the airway or continuous negative pressure (partial vacuum). The review of trials found that continuous distending pressure (CDP) reduces the rate of death or the need for assisted ventilation and reduced the need for IPPV. The small and mostly dated trials also found that CDP can increase the rate of pneumothorax (air outside the lung in the chest cavity).