Association between ventilatory settings and pneumothorax in extremely preterm neonates

Matsushita, Felipe Yu; Krebs, Vera Lúcia Jornada; Carvalho, Werther Brunow de

doi:10.6061/clinics/2021/e2242

Cited by 2 publications

(4 citation statements)

References 16 publications

(21 reference statements)

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“…Other risk factors if the patient is on a ventilator are high flow rates and patient-ventilator asynchrony. 13 In 2021, a study by Matsushita et al 15 demonstrated that high tidal volumes are the largest risk factor for a preterm newborn to develop a pneumothorax. Other respiratory risk factors are endotracheal tube displacement and failure to wean ventilatory support after administering surfactant.…”

Section: Risk Factors For Air Leaksmentioning

confidence: 99%

Management of Air Leaks in the Newborn

Kastein¹,

Coe²

2023

Advances in Neonatal Care

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Background: Air leaks, especially pulmonary interstitial emphysema (PIE), are increasingly uncommon respiratory complications of the newborn. Despite PIE having a decreasing incidence, it continues to have a high morbidity and mortality rate. This makes PIE one of the most severe respiratory complications to affect a newborn. Air leaks occur when there is overdistension of the terminal airways or alveoli, which results in air dissecting into extra-alveolar spaces. Recognizing the signs of air leaks is paramount to allow for appropriate diagnosis and treatment of the newborn to improve morbidity and mortality. Treatment modalities range from positioning the newborn in the decubitus position to surgical intervention. Purpose: To summarize current evidence on the pathophysiology, risk factors, diagnosis, treatment, and management of PIE and pneumothorax. Data Sources: Two databases were systematically reviewed with key words later. Articles in English with date restrictions from 2016 to current were included. Study Selection: Inclusion criteria of randomized controlled trials, case studies/reports, and review articles were utilized. Twenty articles, primarily case reports and studies, were reviewed. Data Extraction: Guidelines for data abstraction were followed via independent extraction by a single observer. Results: Qualitative results were utilized to formulate current treatment of air leaks. Implications for Practice: This article provides guidance for frontline neonatal providers on current treatment and management of air leaks in the newborn population.

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Section: Risk Factors For Air Leaksmentioning

confidence: 99%

Management of Air Leaks in the Newborn

Kastein¹,

Coe²

2023

Advances in Neonatal Care

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“…A few studies have examined the association between detailed acute-phase ventilatory settings and pulmonary air leaks in extremely preterm infants. A single-center retrospective cohort study conducted in Brazil showed that positive end-expiratory pressures or peak inspiratory pressures in extremely low birth weight infants were not associated with a higher risk of pneumothorax during the first 7 days of life ( 10 ). In contrast, several previous studies reported that high peak inspiratory pressures and prolonged inspiratory times were associated with the incidence of pneumothorax in very low birth weight infants ( 13 , 16 ).…”

Section: Discussionmentioning

confidence: 99%

“…We estimated the risk ratios (RRs) and 95% confidence intervals (CIs) for the main outcomes using the low MAP category as a reference after adjusting for potential confounders. We selected possible potential confounders based on previous studies ( 1 , 10 , 13 ), including gestational age (22–23, 24–25, and 26–27 gestational weeks, categorical), pulmonary surfactant administration (dichotomous), prolonged preterm premature rupture of membranes (dichotomous), and clinical risk index for babies (CRIB) II score (≤9, 10–14, and ≥15, categorical) ( 14 ). In further analyses, we excluded infants who received IMV before the occurrence of pulmonary air leak or within the first 7 days of life.…”

Section: Methodsmentioning

confidence: 99%

“…While positive pressure ventilation has been considered an important contributing factor associated with pulmonary air leaks ( 9 ), studies examining the association between specific ventilatory settings and pulmonary air leaks among extremely preterm infants are limited. A single-center retrospective cohort study conducted in Brazil suggested that pressure-related ventilatory settings during intermittent mandatory ventilation (IMV) in extremely low birth weight infants were not associated with a higher risk of pneumothorax in the first 7 days of life ( 10 ). However, to date, no studies have evaluated the association between ventilatory settings on acute-phase high-frequency oscillatory ventilation (HFOV) and pulmonary air leak in extremely preterm infants.…”

Section: Introductionmentioning

confidence: 99%

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Association between mean airway pressure during high-frequency oscillatory ventilation and pulmonary air leak in extremely preterm infants during the first week of life

Tamai,

Takeuchi,

Nakamura

et al. 2024

Front. Pediatr.

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BackgroundWhile positive pressure ventilation has been considered an important contributing factor associated with pulmonary air leaks, studies examining the association between specific ventilatory settings during acute-phase high-frequency oscillatory ventilation (HFOV) and pulmonary air leaks among extremely preterm infants are limited.MethodsThis was a single-center retrospective cohort study conducted at an institution that primarily used HFOV after intubation in extremely preterm infants. We analyzed data from extremely preterm infants born between 2010 and 2021. The primary outcome was pulmonary air leakage during the first 7 days of life. The exposure variable was the maximum mean airway pressure (MAP) on HFOV during the first 7 days of life or before the onset of pulmonary air leaks. Maximum MAP was categorized into three groups: low (7–10 cmH2O), moderate (11–12 cmH2O), and high (13–15 cmH2O) MAP categories. We conducted robust Poisson regression analyses after adjustment for perinatal confounders, using the low MAP category as the reference.ResultsThe cohort included 171 infants (low MAP, 123; moderate MAP, 27; and high MAP, 21). The median (interquartile range) gestational age and birth weight were 25.7 (24.3–26.7), 25.7 (24.9–26.9), and 25.3 (24.3–26.6) weeks and 760 (612–878), 756 (648–962), and 734 (578–922) g for infants in the low, moderate, and high MAP categories, respectively. Compared to infants in the low MAP category, those in the high MAP category had a higher incidence of pulmonary air leaks (4.1% vs. 33.3%; adjusted risk ratio, 5.4; 95% confidence interval, 1.6–18.5). In contrast, there was no clear difference in the risk of pulmonary air leaks between the moderate and low MAP categories (3.7% vs. 4.1%; adjusted risk ratio, 0.9; 95% confidence interval, 0.1–6.1).ConclusionExtremely preterm infants requiring high MAP (≥13 cmH2O) in acute-phase HFOV had a higher risk of pulmonary air leak during the first 7 days of life.

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Association between ventilatory settings and pneumothorax in extremely preterm neonates

Cited by 2 publications

References 16 publications

Management of Air Leaks in the Newborn

Management of Air Leaks in the Newborn

Association between mean airway pressure during high-frequency oscillatory ventilation and pulmonary air leak in extremely preterm infants during the first week of life

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