Continuous positive airway pressure in congenital lobar emphysema.

Continuous positive airway pressure in congenital lobar emphysema Congenital lobar emphysema with air trapping distal to defective bronchial cartilage is an unusual cause of respiratory distress in early infancy.' Prompt treatment, usually lobectomy, may be necessary to maintain ventilation. Until recently medical management had little to offer; indeed, mortality was likely to be increased by this approach.' We describe an infant for whom a period of medical management as a preliniinary to definitive surgery was feasible through maintaining ventilation by continuous positive airway pressure (CPAP). Case report In a 4330-g baby girl severe respiratory distress was present from birth, but expiratory obstruction with over-distension of the right middle and left upper lobes was apparent only after several weeks. To prevent episodes of respiratory failure before surgery, CPAP was maintained through a naso-tracheal tube for 23 weeks. After removal of the grossly emphysematous left upper and right middle lobes she was extubated without difficulty. The East-Radcliffe circuit with "dummy lung," as used for the ventilation of neonates,3 was further modified for spontaneous respiration with CPAP by connecting the expired airport to an underwater blow-off adjusted to the desired pressure, in this case 4-6 cm of water (figure). The ventilator 'Dummy lung" Ventilator Expiratory hibjing Expiratory <3 E;tresistaece f t t I e f f ~ ~ ~ ~ ~ ~ P r s s r gauge .401y915 In"piratorySaeybo-f tubing atybo-f Not water valve humidifier Reservoir bag The East-Radcliffe ventilatory circuit modified for continuous positive airway pressure (CPAP) during spontaneous respiration. switch was placed in the "bag" position and the required oxygen/air mixture was delivered into the oxygen port. A total gas flow of 5 litres per minute was adequate to prevent rebreathing and to maintain an adequate temperature of the humidified gases at the endotracheal tube connector. The air intake port was connected to the reservoir bag, whose blow-off valve was closed, and an additional 10 cm underwater blow-off inserted at this point to prevent excessive pressure should obstruction occur on the expiratory limb. In this way the manometer and the humidifier of the respirator could be used during spontaneous respiration. The reservoir bag gave additional visual indication of the pressure in the circuit and a ready means of producing an artificial sigh or manual ventilation. Intermittent positive-pressure ventilation could be instituted by pushing the ventilator switch to the "pump" position. With Portex ivory vinyl nasal tubes the Tunstall modification of …