Objective: Since there is insufficient data from controlled trials to guide the ventilatory management of neonatal pulmonary interstitial emphysema (PIE), we determined current treatment choices of University-based full-time neonatologists in 20 Canadian NICUs. Methods: A pretested standardized questionnaire was administered by telephone in 1995. Each question referred to an imaginary 1 kg infant who develops PIE on a peak inspiratory pressure (PIP) of 20 cm H2O, PEEP of 4 cm H2O, IPPV rate of 40 breaths per minute in 60% O2. Results: Of 96 eligible clinicians, 88 could be contacted and 55 completed the survey by stating in which direction they would change PIP, PEEP and ranges of ventilator rates: Table Rates were chosen as follows:< 40/min (9%); 40-60/min (44%); 60-80/min (27%); > 80/min (4%); uncertain (16%). Most respondents (89%) would consider using high frequency ventilation (HFV), if available. Conclusions: There was a tendency to reduce PIP and strong agreement about the possible value of HFV. However, opinions about optimum PEEP and desirable ventilator rates were very discordant. Controlled trials are needed to determine optimum conventional ventilator settings in neonatal PIE, or alternatively, to confirm the benefits of HFV.

Table 1
Full size table