Expectant Management of Pneumothorax in Preterm Infants Receiving Assisted Ventilation: Report of 4 Cases and Review of the Literature

Kitsommart, Ratchada; Martins, Bianca; Bottino, Marcela; Sant’Anna, Guilherme M.

doi:10.4187/respcare.01446

Cited by 17 publications

(21 citation statements)

References 17 publications

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“…The presence of persistently high or unequal transpulmonary inflating pressure in the alveoli during the transition period results in rupture of alveoli into the pleural space and produces a spontaneous pneumothorax 6 . The incidence of radiologic SP is 1% to 2% and symptomatic SP is 0.05% to 1% in all live births and in very low birth weight (VLBW) neonates this rate can achieve 3.8% to 9% 1,7,8 . The incidence rate can increase to up to 30% in patients who have concurrent underlying lung disease or who require mechanical ventilation 9,10 .…”

Section: Introductionmentioning

confidence: 99%

Spectrum of Neonatal Pneumothorax at a Tertiary Care Hospital of Bangladesh : A Retrospective Observational Study.

Mannan

Dey

Jahan³

et al. 2019

Bangladesh Crit Care J

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Introduction: Pneumothorax occurs more frequently in the neonatal period than in any other period of life & is associated with increased mortality and morbidity. Several risk factors for pneumothorax, including respiratory pathology, invasive and non-invasive respiratory support & predictors of mortality have been described. Objective: To evaluate the prevalence of pneumothorax, to identify underlying causes & to describe the clinical characteristics, management and outcome of neonates with pneumothorax, as well as to identify predictors of mortality in these neonates. Methods: A retrospective chart review of neonatal records included all neonates hospitalized in the NICU of 'Ad-din Women’s Medical College' Dhaka, between January 2016 & December 2017 with the diagnosis of pneumothorax. The collected data included: demographics & perinatal data, characteristics of pneumothorax, classification, treatment & clinical outcomes. All statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) version 16. Results: Our study included 83 neonates, of whom 48 were male (57.83%) & 60 (72.29%) born by lower uterine caesarean section (LUCS). Median gestational age(GA) was 36 (32-41) weeks & the median birth weight(BW) was 2,558 (1500-3800) grams. The prevalence of neonatal Pneumothorax in our centre was 2.60% & that of Spontaneous Pneumothorax was 1.53%. The analysis of perinatal data showed statistically significant differences in APGAR score at 5th minute (p = <0.00001) & in resuscitation at birth (p < 0.00001). Pneumothorax was significantly associated with RDS, pneumonia, Meconium aspiration syndrome (MAS) & Perinatal asphyxia (PNA), (p=0.235893) and all (n=6) death were observed in neonates who had coexisting diseases, (p=0.00226). Forty nine (59.04%) was SP (p = 0.002) & mainly observed in the right lung (77.11 %( (p=0.00011). To treat the pneumothoraces, 64 (77.11%) neonates only received oxygen therapy, 16 (19.28%) neonate needed MV along with chest tube (CT) drain, 02(2.41%) thoracentesis with needle aspiration, and 01 (1.20%) needle aspiration & chest tube (CT) drain (p <0.00001). Clinical data suggest that complications such as sepsis, severe hypotension, Necrotizing enterocolitis (NEC), DIC, Intraventricular haemorrhage (IVH) can negatively affect immediate outcomes (p=0.00025). The mortality rate was 7.23%. All the mortalities observed in neonates who got respiratory support with mechanical ventilation (MV) along with CT insertion (p=<0.00001). Hypotension, sepsis, DIC, IVH, MV and thoracentesis followed by a CT insertion were found to be predictors of mortality in neonates with pneumothorax. Conclusion: NP may develop during the neonatal period, especially in the presence of underlying clinical conditions, and neonates with pneumothorax managed with CT drain and respiratory support (MV), despite treatment have a high mortality rate. Bangladesh Crit Care J March 2019; 7(1): 12-19

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Section: Introductionmentioning

confidence: 99%

Spectrum of Neonatal Pneumothorax at a Tertiary Care Hospital of Bangladesh : A Retrospective Observational Study.

Mannan

Dey

Jahan³

et al. 2019

Bangladesh Crit Care J

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“…Recently Kitsommart et al [ 4 ] reported 4 cases of preterm infants who developed large pneumothoraces, two of whom remaining on nasal CPAP after the diagnosis. In our experience, all the neonates developed worsening respiratory severity in terms of increasing of respiratory rate, Silverman score, FiO 2 requirement and PCO 2 values, making intubation mandatory.…”

Section: Discussionmentioning

confidence: 99%

“…A 40% increase of FiO 2 during the first 24 h of CPAP has been suggested as a useful marker to identify the infants at high risk of developing a pneumothorax [ 3 ]. Recently successful management strategies have been reported of symptomatic pneumothorax diagnosed in preterm infants receiving assisted ventilation, which avoided chest tube drainage and resulted in reduction of important side effects [ 4 , 5 ]. In this case series, we reported our experience of using high-frequency oscillatory ventilation (HFOV) as a first-line treatment of pneumothorax in preterm infants with respiratory distress syndrome.…”

Section: Introductionmentioning

confidence: 99%

Management of pneumothorax in hemodynamically stable preterm infants using high frequency oscillatory ventilation: report of five cases

et al. 2017

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BackgroundDespite an increased use of non-invasive ventilatory strategies and gentle ventilation, pneumothorax remains a common complication in preterm infants. The ventilator management of infants with air leaks remains challenging in terms of both prevention and treatment. Recently the safety and efficacy of expectant management avoiding chest tube drainage to treat large air leak in preterm infants hemodynamically stable has been reported.Case presentationIn the present study, we report five cases of preterm infants with birth weight ≤ 1250 g affected by respiratory distress syndrome and treated with nasal continuous positive airway pressure as first intention. They were intubated for worsening of respiratory distress with increasing oxygen requirement and concomitant increase of respiratory rate and PCO2 values due to occurrence of pneumothorax, and they were successfully treated using high-frequency oscillatory ventilation without chest tube insertion.ConclusionIn our experience high-frequency oscillatory ventilation provided a conservative management of a significant pneumothorax in preterm newborns hemodynamically stable and requiring mechanical ventilation. This approach allowed us to avoid the increasing of air leak and the insertion of chest tube drainage and all the subsequent associated risks.

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“…17,19,20 Although some infants may be managed expectantly, many have acute decompensation requiring immediate intervention with chest tube placement. 17,[20][21][22] Incorrect placement of chest tubes may be associated with serious complications, including perforation of the lung 23 ; misplacements into the liver, peritoneal space, heart, spleen, subclavian vessels, colon, esophagus, and inferior vena cava 24 ; and phrenic nerve paralysis. 25 All practitioners who take care of critically ill infants should learn to insert chest tubes properly.…”

Section: Discussionmentioning

confidence: 99%

An Innovative Nonanimal Simulation Trainer for Chest Tube Insertion in Neonates

Gupta

Ramasethu

2014

Pediatrics

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BACKGROUND AND OBJECTIVE: Competence in the chest tube insertion procedure is vital for practitioners who take care of critically ill infants. The use of animals for training is discouraged, and there are no realistic simulation models available for the neonatal chest tube insertion procedure. The objective of this study was to assess the effectiveness of teaching the chest tube insertion procedure by using an easily constructed, nonanimal simulation model. METHODS: An inexpensive infant chest tube insertion model was developed by using simple hardware. A prospective cohort study with pre-posttest intervention design was conducted with pediatric and combined internal medicine–pediatrics residents. Residents completed a questionnaire about their previous experience of chest tube insertion, knowledge, self-evaluation of knowledge, comfort, and skills; pre, post, and a month after an individualized education session and demonstration of the procedure on the model. Clinical skills were assessed by using a 32-point scoring system when residents performed the procedure on the model immediately after training and a month later. RESULTS: All residents had significant improvement in knowledge and self-evaluation of knowledge, comfort, and skills scores after the education session and training on the model and this improvement was retained after 1 month (P < .001). Clinical skills scores decreased slightly 1 month after training (P = .08). Scores were not significantly different between the levels of trainees. CONCLUSIONS: An educational intervention using an easily constructed and inexpensive chest tube insertion model is effective in improving knowledge, comfort, and skills in trainees. The model can be used repeatedly to maintain proficiency.

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Expectant Management of Pneumothorax in Preterm Infants Receiving Assisted Ventilation: Report of 4 Cases and Review of the Literature

Cited by 17 publications

References 17 publications

Spectrum of Neonatal Pneumothorax at a Tertiary Care Hospital of Bangladesh : A Retrospective Observational Study.

Spectrum of Neonatal Pneumothorax at a Tertiary Care Hospital of Bangladesh : A Retrospective Observational Study.

Management of pneumothorax in hemodynamically stable preterm infants using high frequency oscillatory ventilation: report of five cases

An Innovative Nonanimal Simulation Trainer for Chest Tube Insertion in Neonates

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