Pulmonary interstitial emphysema in very low birthweight infants.

Hart, Solveig; McNair, M; Gamsu, H R; Price, John

doi:10.1136/adc.58.8.612

Cited by 69 publications

(40 citation statements)

References 12 publications

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“…a low peak inspiratory pressure (PIP) with a short inspiration time [7]. On the other hand over-ventilation sometimes causes pulmonary interstitial emphysema and pneumothorax [9,12] due to a high PIP [8]. Use of an online manometer prevents both a low and a high PIP [19].…”

Section: Introductionmentioning

confidence: 98%

The effect of a manometer on the mean airway pressure during hand ventilation, an in vitro study

1989

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The effect of an on-line manometer on the variables of ventilation i.e. peak inspiratory pressure (PIP), mean airway pressure (MAP), positive end expiratory pressure (PEEP), and inspiratory to expiratory time ratio (I:E) was studied in vitro. Analysis of PIP, MAP, PEEP, and I:E was made during hand ventilation of a resuscitation mannequin at the preselected PIP of 15 and 25 cm water with and without a manometer. Use of the manometer decreased the range of variation in PIP, but the MAP was higher. This was due to an increased I:E while PEEP remained unchanged. An on-line manometer during hand ventilation prevents excessive PIP but may increase the MAP and therefore may not prevent development of a pneumothorax.

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Section: Introductionmentioning

confidence: 98%

The effect of a manometer on the mean airway pressure during hand ventilation, an in vitro study

1989

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“…Prolonged intubation and mechanical ventilation in the neonate has been linked with several complications including bronchopulmonary dysplasia, nosocomial pneumonia, air leak syndromes and subglottic stenosis [1,2,3]. As such, there has been an effort to reduce the duration of endotracheal intubation to help minimize these adverse effects [4].…”

Section: Introductionmentioning

confidence: 99%

Nasal High-Frequency Oscillation for Lung Carbon Dioxide Clearance in the Newborn

Mukerji

Finelli²,

Belik³

2012

Neonatology

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Background: Noninvasive ventilation has been used increasingly in recent years to minimize the duration of endotracheal mechanical ventilation in neonates due to its association with lung injury. Nasal high-frequency oscillation (nHFO) is a relatively new noninvasive modality but evidence for its use is limited. Objective: The goal of this study was to compare the CO₂ clearance efficacy of nHFO and noninvasive positive pressure ventilation (NIPPV) in a neonatal lung model. Design/Methods: A newborn mannequin with dimensions and anatomy similar to a term infant was utilized. It was connected to a commercially available neonatal mechanical ventilator using a manufacturer-provided nasal adaptor. Various modes of noninvasive ventilation were compared as CO₂ clearance was measured at the oropharynx by an end-tidal CO₂ analyzer following the addition of a known amount of CO₂ into the lung. Measurements were obtained at two different lung compliances using nHFO and compared with nCMV and nasal continuous positive airway pressure (nCPAP) as a control. Pressures near the nasal adaptor and the larynx were simultaneously measured with in-line pressure transducers. Results: Whereas no CO₂ elimination was observed under nCPAP, its clearance with nHFO was 3-fold greater as compared to NIPPV. On nHFO, CO₂ clearance was inversely proportional to frequency and maximal at 6 and 8 Hz. At a lower lung compliance, CO₂ clearance was significantly higher at 6 Hz as compared to 10 Hz. During nHFO set to deliver a MAP of 10.0, we documented pressures of 7.2 ± 0.3 at the nasal adaptor and only 2.3 ± 0.3 cm H₂O at the larynx. Conclusions: Nasal HFO is effective and superior to NIPPV at lung CO₂ elimination in a newborn mannequin model. The use of nHFO as the preferred mode of noninvasive ventilation warrants further clinical studies.

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“…However, these have not been reported with short courses of dexamethasone [15,20]. The survival of all infants who received 3 doses of dexamethasone (9/10 overall) is superior to the reported mortality rates of 50-80% in VLBW infants (Bsurfactant) with severe PIE [2,3,8,9]. This may, in part, reflect the fact that the majority of infants developed this complication after the acute phase of their lung disease and were more likely to survive this complication (lateonset PIE).…”

Section: Discussionmentioning

confidence: 79%

“…This may result in impaired pulmonary blood flow, decreased lung compliance and in-creased airway resistance [6,7]. The mortality of infants with PIE that were managed with conventional mechanical ventilation in the pre-surfactant 1980s was reported to be as high as 67% [8] and 80% [6]. Infants with PIE who are at greatest risk of dying are those of very low birthweight (!1,500 g) who receive high peak inspiratory pressures (125 cm H 2 O) during the first 24 h of life [9].…”

Section: Introductionmentioning

confidence: 99%

Dexamethasone for Pulmonary Interstitial Emphysema in Preterm Infants

Fitzgerald

Willis²,

Usher³

et al. 1997

Neonatology

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The efficacy of a 3-day course of dexamethasone (0.5 mg/kg/day) in 10 preterm infants (≤30 weeks gestation) with pulmonary interstitial emphysema (PIE) was studied in a retrospective case review. PIE was diagnosed at a median age of 7.5 days and treatment with dexamethasone began at 8.5 days. Seven of the 10 subjects had at least 2 days of conservative treatment (lowered mean airway pressure) preceding dexamethasone during which the mean airway pressure (MAP), oxygenation index (OI) and mechanical ventilation index (MVI) were not significantly different although within 3 days of dexamethasone each variable improved significantly (p < 0.05). Similarly, for all 10 infants, OI and MAP were significantly lower at 3 and 7 days from baseline (p < 0.005). By day 7, FiO₂ (p = 0.022) and MVI (p = 0.011) were significantly lower and PIE had resolved on chest X-ray in 7/9 (78%) and improved in the remaining 2/9 (22%). Nine of the 10 infants survived to term. Three days of dexamethasone was associated with significant clinical improvement in most of these infants. The mechanism may relate to reduced airway oedema and inflammation and reduced airway obstruction.

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Pulmonary interstitial emphysema in very low birthweight infants.

Cited by 69 publications

References 12 publications

The effect of a manometer on the mean airway pressure during hand ventilation, an in vitro study

The effect of a manometer on the mean airway pressure during hand ventilation, an in vitro study

Nasal High-Frequency Oscillation for Lung Carbon Dioxide Clearance in the Newborn

Dexamethasone for Pulmonary Interstitial Emphysema in Preterm Infants

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