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

[Leonora DEsposito]

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 .

[Stefan Johansson]

Could you upload an x-ray?

It is hard to say but it seems plausible that the pneumo contributes to the respiratory distress.

You could try to evacuate the pneumo once again with a needle. If air returns on x-ray, you def have a leak which probably needs to heal under drainage.

[Guest urai06]

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

[Leonora DEsposito]

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.

[Stefan Johansson]

Happy ending then!

Glad to hear that you managed your case with a conservative strategy.

General comment: aggressive active strategies are is always easy, sometimes they are not necessary.

[Guest dask]

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 .

[Guest urai06]

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

uraiwn

[KBOUDHARHCA]

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.

[JACK]

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

[KBOUDHARHCA]

100% FiO2 is no longer recommended

is recommended for full term newborn during short period

[nashwa]

i want your openion about fistula falsely introduced by chest tube