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Crew, A. D., Varkonyi, P. I., Gardner, L. G., Robinson, Q. L. A., Wall, E., and Deverall, P. B. (1974). Thorax , 29 , 437-445. Continuous positive airway pressure breathing in the postoperative management of the cardiac infant. Continuous positive airway pressure with spontaneous ventilation was used in the postoperative period following palliative or corrective surgery for congenital heart defects in a group of children of less than 3 years of age. After stabilization of the cardiovascular state, continuous positive airway pressure breathing (CPAP) was shown to be a suitable alternative to continuous positive pressure ventilation (CPPV). A statistically significant increase in PaO2 was observed on changing from CPPV to CPAP. A statistically significant decrease in PaO2 and increase in pulmonary venous admixture was observed after discontinuing the positive airway pressure and allowing the patient to breathe at ambient pressure. We would recommend CPAP as an intermediate manoeuvre in the withdrawal of ventilatory support as it introduces a smoothness and stability into patient management regimes which was previously lacking. Careful selection of apparatus is necessary as the airway pressure should be truly continuous and steady. In neonates the dead space of the system should be reduced to a minimum; CPAP alternating with periods on CPPV may be necessary for some time after cardiovascular stability has been attained.

CPAP is a technique of respiratory care which was originally described in the management of the respiratory distress syndrome of the newborn and later in the post operative management of the cardiac infant following surgery. It has potential value in the respiratory management of older children and adults. Apparatus is described suitable for the application of continuous airway pressure during spontaneous ventilation via endotracheal tube in either neonates or adults. The inspired oxygen content is adjustable and the fresh gas warmed and humidified. High and low pressure alarms are not considered necessary. A head-harness is described for the application of CPAP in neonates via twin nasal or nasopharyngeal tubes. This equipment may be obtained from Messrs. Lusterlite Products Limited, 56 Devon Road, Leeds 2.