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Management of pneumothorax in hemodynamically stable preterm infants using high frequency oscillatory ventilation:

Claudia Aurilia1, Cinzia Ricci1, Milena Tana1

  • 1Division of Neonatology, Department for the protection of women's health and the nascent life, child and adolescent, Fondazione Policlinico Universitario A. Gemelli-Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy.

Italian Journal of Pediatrics
|December 24, 2017
PubMed

Insights

High-frequency oscillatory ventilation offers a safe, conservative approach for managing pneumothorax in preterm infants. This method successfully treated air leaks without requiring chest tube insertion, minimizing associated risks.

Area of Science:

  • Neonatal Medicine
  • Pediatric Respiratory Medicine
  • Critical Care

Background:

  • Pneumothorax is a frequent complication in preterm infants despite advances in ventilation.
  • Managing air leaks in neonates presents significant clinical challenges.
  • Conservative expectant management for air leaks in stable preterm infants has shown promise.

Purpose of the Study:

  • To evaluate the efficacy of high-frequency oscillatory ventilation (HFOV) in treating pneumothorax in preterm infants.
  • To assess the feasibility of avoiding chest tube insertion in these cases.

Main Methods:

  • Retrospective case series of five preterm infants (birth weight ≤ 1250g) with respiratory distress syndrome.
  • Initial treatment with nasal continuous positive airway pressure (nCPAP).
  • Intubation and treatment with HFOV for worsening respiratory distress and pneumothorax, without chest tube drainage.

Main Results:

  • All five preterm infants with pneumothorax were successfully managed with HFOV.
  • This approach avoided the need for chest tube insertion.
  • No increase in air leak or associated complications were observed.

Conclusions:

  • HFOV provides a viable conservative management strategy for significant pneumothorax in hemodynamically stable preterm newborns requiring mechanical ventilation.
  • This HFOV strategy can effectively prevent worsening air leaks and the need for chest tube drainage, thereby avoiding associated risks.
Abstract

Keywords:
Chest drainageHFOVPneumothoraxPreterm infants

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