Resolution of acquired lobar emphysema withdexamethasone therapy

Mohsini, K. G.; Reid, David; Tanswell, Keith

doi:10.1016/s0022-3476(87)80215-9

Cited by 16 publications

(13 citation statements)

References 7 publications

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“…The only medications reported to have a role in the management of PIE are steroids [5]. Minimal pressure conventional ventilation and high-frequency ventilation are the mainstays of PIE management, but positioning and ECMO may also have a role.…”

Section: Discussionmentioning

confidence: 99%

Management of Pulmonary Interstitial Emphysema in a Premature Infant using Nasopharyngeal High-Frequency Oscillatory Ventilation

Tawil¹,

Ahmed²,

Tawakol³

2011

J Pulmonar Respirat Med

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Pulmonary interstitial emphysema in mechanically ventilated premature infants is a serious complication that is difficult to manage and is associated with a poor prognosis [1]. We describe a premature infant with respiratory insufficiency secondary to severe pulmonary interstitial emphysema that was managed with nasopharyngeal highfrequency oscillatory ventilation, as a non-invasive mode of ventilation.Our case report does not clearly differentiate whether the improvement in gas exchange and eventual resolution of PIE are attributable to the use of non-invasive HFOV or to the use more appropriate low frequency (7Hz) with the non-invasive approach. Further studies of NP-HFOV use in infants with PIE are needed to support our report Conclusion: NP-HFOV may be utilized in infants with PIE associated with compromised respiratory function. NP-HFOV may decrease the chance of further pulmonary complications, including pneumonia and lung atelectasis, and facilitate care of sick infants while on NP-HFOV.

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Section: Discussionmentioning

confidence: 99%

Management of Pulmonary Interstitial Emphysema in a Premature Infant using Nasopharyngeal High-Frequency Oscillatory Ventilation

Tawil¹,

Ahmed²,

Tawakol³

2011

J Pulmonar Respirat Med

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“…All patients received 3 days of systemic dexamethasone (0.5 mg/kg/day) for worsening gas exchange in association with radiological evidence of severe PIE [4,5]. The outcome measures included: MAP, FiO 2 , arterial blood gas tensions, 'mechanical ventilation index' [10] [MVI = (peak inspiratory pressure -positive end-expiratory pressure) ! inspiratory time setting !…”

Section: Methodsmentioning

confidence: 99%

“…Secondly, lateral decubitus positioning for 3 days was associated with radiological resolution of 'tension PIE' in 19/21 milder cases whilst their 'respiratory status either improved or remained stable' [7]. Thirdly and most interestingly, Mohsini et al [10] reported that systemic dexamethasone (7-to 12-day course with differing doses) resulted in decompression of acquired lobar emphysema complicating late-onset PIE (after the 1st week) in 3 low birthweight infants aged 2, 4 and 8 weeks. Prompted by the report of Mohsini et al [10], we began prescribing a standardised course of dexamethasone for ventilator-dependent premature infants presenting with PIE and worsening gas exchange in 1994.…”

Section: Introductionmentioning

confidence: 91%

“…In the last decade, three successful, nonoperative treatments for PIE have been reported [3,7,10]. High-frequency jet ventilation (HFJV) lowered mean airway pressures (MAP) and reduced mortality in surfactanttreated infants who developed early-onset PIE (in the 1st week of life) [3].…”

Section: Introductionmentioning

confidence: 99%

“…Thirdly and most interestingly, Mohsini et al [10] reported that systemic dexamethasone (7-to 12-day course with differing doses) resulted in decompression of acquired lobar emphysema complicating late-onset PIE (after the 1st week) in 3 low birthweight infants aged 2, 4 and 8 weeks. Prompted by the report of Mohsini et al [10], we began prescribing a standardised course of dexamethasone for ventilator-dependent premature infants presenting with PIE and worsening gas exchange in 1994. In this paper, we report our experience with systemic dexamethasone (0.5 mg/kg/day for 3 days) for severe PIE in 10 consecutive infants over a period of 18 months.…”

Section: Introductionmentioning

confidence: 99%

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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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Successful treatment of severe neonatal lobar emphysema by high‐frequency oscillatory ventilation

Kohlhauser

Popow

Helbich

et al. 1995

Pediatric Pulmonology

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We successfully used high-frequency oscillatory ventilation (HFOV) for treating severe acquired lobar emphysema in two premature newborn infants (birth weights, 1,450 and 1,300 g). After successful weaning from mechanical ventilation for hyaline membrane disease, they needed additional ventilatory support because they developed severe lobar emphysema compressing the residual lung. In both patients, radiographic signs of lobar emphysema disappeared completely after 3 days of HFOV. Diagnosis and follow-up were confirmed by high-resolution computed tomography. We conclude that HFOV may be a useful noninvasive method for treating severe lobar emphysema.

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Resolution of acquired lobar emphysema withdexamethasone therapy

Cited by 16 publications

References 7 publications

Management of Pulmonary Interstitial Emphysema in a Premature Infant using Nasopharyngeal High-Frequency Oscillatory Ventilation

Management of Pulmonary Interstitial Emphysema in a Premature Infant using Nasopharyngeal High-Frequency Oscillatory Ventilation

Dexamethasone for Pulmonary Interstitial Emphysema in Preterm Infants

Successful treatment of severe neonatal lobar emphysema by high‐frequency oscillatory ventilation

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