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Improved prognosis of infants mechanically ventilated for hyaline membrane disease

The results of mechanical ventilation for severe hyaline membrane disease (HMD), and the changes in technique which took place, during the 6-year period 1967-72 are described. A pilot study of the effect of hydrocortisone among the most severely affected infants showed no benefit. After the introduction at the beginning of 1970 of a regimen for ventilating the infants at low peak airway pressures, slow respiratory frequencies, and high inspiration: expiration ratios, there was a sudden increase in survival rate which was largely accounted for by a reduction in the incidence of bronchopulmonary dysplasia. Evidence is presented that in infants with HMD mechanical factors are more important than oxygen toxicity in the pathogenesis of this condition.