Vital Times 2020 - 95

15% survival rate. A lack of understanding of neonatal
pulmonary physiology often resulted in ineffective
mechanical ventilation.2
As he ran through the management options for the
deteriorating newborn, the young anesthesiologist
thought of a recent paper, which posited that many
babies with hyaline membrane disease grunted as
they breathed spontaneously in order to stent alveoli
open at end expiration.3 Based on this information, he
wondered if the application of positive end-expiratory
pressure (PEEP) would help keep his colleague's child
alive.

as described above, and 2) using a plastic pressure
chamber without an endotracheal tube. The latter
method made him the first to apply CPAP without
intubation.5 Originally called the " Gregory box, " this
plastic chamber surrounded the infant's head and
had openings for fresh gas inflow and outflow. The
chamber itself could be squeezed manually to apply
positive pressure.5

In a stroke of genius, he applied 8 cm H2O of PEEP
using an Ayres T-piece. The T-piece was connected
to fresh gas flow as well as a reservoir bag, and the
system could be pressurized either by squeezing the
bag or by adjusting the flow rates. Holding his breath,
he followed up with blood gas analysis and noted that
the PaO2 had risen to 80 mmHg, then to 230 mmHg,
over the next hour. He could hardly believe that he
was actually able to lower the fraction of inspired
oxygen!
This memorable night changed the course of Dr.
George Gregory's career, and with it, the history of
pediatric anesthesia internationally. He began to
study neonatal pulmonary compliance and resistance
and measured functional residual capacity with
and without PEEP. He performed an initial study on
neonates with respiratory distress syndrome and
found that none of the first babies treated with nasal
continuous positive airway pressure (CPAP) had
developed chronic lung disease. The survival rate
went from 15% in 1960 to 85% by 2000.2
In Dr. Gregory's landmark New England Journal of
Medicine publication in 1971, he presented two
methods to apply CPAP: 1) via an endotracheal tube

George Gregory, MD

Dr. George Gregory's Life and
Contributions
Dr. Gregory was born in Denver, Colorado. At 8
years of age, an abscess formed on his leg, and the
immediate alleviation of pain when it was lanced

Annual Publication 2020

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