ABSTRACT
Some reports in the literature have suggested that endotracheal intubation may increase the risk for chronic lung disease (CLD) in preterm infants. Stern and co-workers noted that bronchopulmonary dysplasia (BPD) was rare in infants ventilated using negative-pressure respirators and concluded that, in addition to exposure to high oxygen, chronic lung disease in infants required exposure to positive pressure or an endotracheal tube (1). More recently, in a retrospective study of nursery practices, Avery and co-workers found that the incidence of chronic lung disease appeared to be lowest in intensive care units that relied on nasal application of continuous positive airway pressure (NCPAP), rather than endotracheal intubation (2). Although there are multiple ways in which endotracheal intubation might contribute to chronic lung disease in infants, this chapter will concentrate on two:
1. Interference with normal warming and humidification of inspired gas by the nose and upper pharynx
2. Increased risk of aspiration
210 Gomez and Hansen
Because there is a considerable amount of information about the first of these, warming and humidifying inspired gas, much of this chapter focuses on this important issue.
