Lack of association between barotrauma and air leak in hyaline membrane disease.

A retrospective analysis of 632 infants with hyaline membrane disease admitted to this regional intensive care nursery between 1 July 1974 and 31 December 1982 showed that 387 (61%) received mechanical ventilation. The ventilator pressures at the time the first air leak was detected were available from the records of 120 of 154 (78%) of the infants who sustained pulmonary air leak. There was a significant downward trend in both peak and end expiratory pressure used during the study period. The downward trend in peak pressure persisted when inborn and outborn infants, boys and girls, and infants more than 27, and 23 to 27 weeks' gestation were examined separately. Despite these trends there was no reduction in the incidence of pulmonary air leak in any group. These data do not support the hypothesis, implicit in the term barotrauma, that a reduction in ventilator pressures decreases the risk of air leak.