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Pneumothorax in a "stable"ventilated infant .Immediate chest tube or wait and see ??

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:confused:

This is about a 2 days old baby 36weeks,delivered by C section. Mother with urinary infection.

Dx with Pneumonia. Developed respiratory distress,managed with Survanta plus nasal CPAP.

X rays with Pneumothorax.Evacuated by needle puncture .(32cc of air ).

Persistent distress,intubated and with mechanical ventilation improved.

New X rays with 30 % ?? pneumothorax .Attending decided not to place chest tube.

Big controversy..I would like to hear your opinion in this case. Regards .

comment_2874

I would like to see CXR too.I have experience for pneumothorax and do not on chest tube by using CPAP instead of ventilator ith 100% Oxygen.

Uraiwan

  • Author

Dear colleagues .I'm sorry ,but I can't upload the X rays. In the middle of this case we experienced problems with Radiology.Poor quality films.:(

Case update: baby doing better,no pneumothorax today.Ready for CPAP.Thanks for your opinion.:)

  • 3 weeks later...
comment_2961
:confused:

This is about a 2 days old baby 36weeks,delivered by C section. Mother with urinary infection.

Dx with Pneumonia. Developed respiratory distress,managed with Survanta plus nasal CPAP.

X rays with Pneumothorax.Evacuated by needle puncture .(32cc of air ).

Persistent distress,intubated and with mechanical ventilation improved.

New X rays with 30 % ?? pneumothorax .Attending decided not to place chest tube.

Big controversy..I would like to hear your opinion in this case. Regards .

comment_2965

We can extubate the patient if patient can on low CPAP and can breath well, not distress with high FiO2.

uraiwn

  • 3 months later...

The CPAP nasal are contribuate to product the pneumothorax, Intubated favorise the pneumothorax.

FiO2 at 100% is indicated.

If the pneumothorax is installeted with méchanical ventilation + PIP hight 25, place tube is indicated.

FiO2 at 100% is indicated.

.

100% FiO2 is no longer recommended

Sola A, Saldeño YP, Favareto V. Clinical practices in neonatal oxygenation:

where have we failed? What can we do? J Perinatol. 2008 May;28 Suppl 1:S28-34.

Review. PubMed PMID: 18446174.

LINK to DOWNLOAD

  • 7 months later...

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