RANDOMIZED TRIAL OF ROUTINE VERSUS SELECTIVE PARALYSIS DURING VENTILATION FOR NEONATAL RESPIRATORY-DISTRESS SYNDROME

The strategy of non-selective nueromuscular paralysis was compared wit h that of synchronised (fast rate) ventilation and selective paralysis in infants receiving mechanical ventilation for respiratory distress syndrome with chronic lung disease as the primary outcome measure. One hundred and ninety three infants weighing under 2000 g were randomly allocated to receive either pancuronium during mechanical ventilation in the acute phase of respiratory distress syndrome (non-selective gro up) or synchronised ventilation (initial ventilatory rate at or above that of the infant's) (selective group). Infants in the selective grou p received pancuronium if they were consistently expiring during the i nspiratory phase of the ventilator cycle. There was no significant dif ference between the groups with respect to birth weight, gestation, an d sex distribution. There was no significant difference between the gr oup with respect to death (selective 19%, non-selective 16%), pneumoth orax (selective 14%, non-selective 14%), chronic lung disease (selecti ve 49%), non-selective 47%), and oxygen dependency at 36 weeks' postme nstrual age (selective 32%, non-selective 39%). Routine paralysis of v entilated infants has potential complications that may be avoided by u sing synchronised ventilation. As the latter is not associated with an increased incidence of long term respiratory complications, it is con cluded that it is the optimum strategy of the two for ventilating infa nts with respiratory distress syndrome.