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Title: Respiratory system compliance measurements in the care of mechanically ventilated new-born infants
Author: Stenson, Benjamin J.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1995
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The studies described in this thesis represent an attempt to determine the clinical value of routine measurements of static respiratory system compliance (Crs) using the single breath passive expiratory flow technique and their suitability for introduction into routine practice. Measurements of Crs were found to be reproducible and safe but because of technical problems up to 20% of attempted measurements in unsedated ventilated infants were unsuccessful. Junior doctors were found to perform poorly at estimating Crs. They disagreed with one another as well as with the measurements. Many clinical circumstances were encountered where Crs data appeared to be useful. Early improvements in Crs were seen following the treatment of respiratory distress syndrome with a natural surfactant that were not seen when an artificial surfactant was administered. These changes may go some way towards explaining the mechanism of action of surfactant replacement therapy in human infants with RDS and the differences in clinical response observed between surfactant preparations. Crs measurements demonstrated some potential as a means of selecting infants for surfactant treatment. In a randomised controlled trial enrolling 245 infants regular measurements of Crs as an additional guide to ventilator management did not impact on the frequency of major adverse neonatal outcomes or reduce the duration of ventilator or oxygen dependence. On the basis of these studies it may be concluded that although measurements of Crs using the single breath passive expiratory flow techniques have a clear place in research they are probably unsuitable for introduction into routine practice. The real value of alternative methodologies should now be urgently evaluated as they are already being introduced into practice by equipment manufacturers.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available