Selective lung ventilation in the management of unilateral pulmonary interstitial emphysema

Liz, Catarina Ferraz; Novo, Ana; Nascimento, M.; Ferreira-Magalhães, Manuel; Carvalho, Cármen; Proença, Elisa

doi:10.1111/jpc.14794

Cited by 3 publications

(5 citation statements)

References 9 publications

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“…If a newborn is on a ventilator, decrease the positive inspiratory pressure, positive end-expiratory pressure, and inspiratory time to decrease mean airway pressure 3. If unilateral PIE is present, selective ventilation of the contralateral lung will allow the affected lung to heal and may prevent the need for surgical resection 21. However, this practice is controversial and may have potential risks as well.…”

Section: Treatment and Management Of Air Leaksmentioning

confidence: 99%

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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: Treatment and Management Of Air Leaksmentioning

confidence: 99%

“…3 If unilateral PIE is present, selective ventilation of the contralateral lung will allow the affected lung to heal and may prevent the need for surgical resection. 21 However, this practice is controversial and may have potential risks as well.…”

Section: Treatment For Piementioning

confidence: 99%

Management of Air Leaks in the Newborn

Kastein¹,

Coe²

2023

Advances in Neonatal Care

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“…This includes non-invasive ventilation, volume control, or high-frequency ventilation, all of which have been found effective in minimizing the development of PIE (8,29). Other treatment methods that have been reported to successfully resolve PIE include lateral decubitus position, selective main bronchial intubation or occlusion, lung puncture, and lobectomy (7,(30)(31)(32)(33)(34)(35)(36). In our case report, we attempted conventional strategies such as the lateral decubitus position, gentle ventilation with shortened inspiratory time, reduced PIP, adjusted PEEP, HFOV with decreased MAP, and non-invasive ventilation.…”

Section: Discussionmentioning

confidence: 94%

Case Report: Neurally adjusted ventilatory assist as an effective rescue treatment for pulmonary interstitial emphysema in extremely low birth weight infants

Chen,

Chung,

Kang

et al. 2024

Front. Pediatr.

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Pulmonary interstitial emphysema (PIE) is a complication observed in extremely low birth weight (ELBW) infants on mechanical ventilation. Despite various proposed therapeutic interventions, the success rates have shown inconsistency. Neurally adjusted ventilatory assist (NAVA) stands out as a novel respiratory support mode, offering lower pressure and tidal volume in comparison to conventional ventilation methods. In this case report, we present five ELBW infants with refractory PIE who were transitioned to NAVA ventilation. Following the switch to NAVA, all cases of PIE gradually resolved. In contrast to traditional modes, NAVA provided respiratory support with significantly lower fraction of inspired oxygen, reduced peak inspiratory pressure, diminished mean airway pressure, and decreased tidal volume within 7 days of NAVA utilization (p = 0.042, 0.043, 0.043, and 0.042, respectively). Consequently, we propose that NAVA could serve as a valuable rescue treatment for ELBW infants with PIE.

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“…In unilateral pneumatoceles, decubitus positioning with the affected side down is a measure that can be adopted to reduce aeration, and consequently, ventilatory pressures in the affected lung 62 . Selective intubation of the main bronchus of the uninvolved lung or elective bronchial occlusion with balloon catheter of the affected side have been successfully used to treat unilateral air leak syndromes, such as recalcitrant pneumothorax, PIE and pneumatoceles 63‐71 …”

Section: Methodsmentioning

confidence: 99%

“…62 Selective intubation of the main bronchus of the uninvolved lung or elective bronchial occlusion with balloon catheter of the affected side have been successfully used to treat unilateral air leak syndromes, such as recalcitrant pneumothorax, PIE and pneumatoceles. [63][64][65][66][67][68][69][70][71] In bilateral cases of pneumatocele, or complicated, severe unilateral cases, the conservative option is image-guided percutaneous catheter drainage. 21 Some advocate percutaneous drainage of infected pneumatoceles, especially if fluid-or pus-filled, to prevent the development of a severe lung abscess that may require surgical excision.…”

Section: Conservative Managementmentioning

confidence: 99%

Pulmonary pneumatoceles in neonates

Rocha

2020

Pediatric Pulmonology

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Pulmonary pneumatoceles were relatively common in neonates in the pre‐surfactant era. In the current era of surfactant, noninvasive and gentle invasive ventilation there is a paucity of data on clinical characteristics and outcomes of pneumatoceles in neonates. The lesion generally resolves spontaneously, but a few cases follow a complicated course with formation of extensive and expanding lesions. To better understand the pathophysiology, clinical significance, natural history, complications, treatment options and prognosis of pulmonary pneumatoceles in neonates, an extensive research was performed on the databases of medical literature. The information collected in this review is important for the clinicians in decision‐making, especially in the most difficult cases.

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Selective lung ventilation in the management of unilateral pulmonary interstitial emphysema

Cited by 3 publications

References 9 publications

Management of Air Leaks in the Newborn

Management of Air Leaks in the Newborn

Case Report: Neurally adjusted ventilatory assist as an effective rescue treatment for pulmonary interstitial emphysema in extremely low birth weight infants

Pulmonary pneumatoceles in neonates

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