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[Treatment of unilateral space-occupying pulmonary interstitial emphysema with positioning measures and
L Gortner1, F Pohlandt, P Bartmann
1Universitäts-Kinderklinik Ulm.
Insights
This study presents a successful treatment for unilateral tension pulmonary interstitial emphysema (PIE) in very low birthweight infants. A specific ventilation strategy resolved PIE within days, improving respiratory support needs.
Area of Science:
- Neonatal Medicine
- Respiratory Physiology
- Pediatric Critical Care
Context:
- Very low birthweight infants often experience respiratory distress syndrome, sometimes complicated by pulmonary interstitial emphysema (PIE).
- Unilateral tension PIE presents a significant challenge in neonatal respiratory management.
- Conventional ventilation strategies may not always be sufficient for severe PIE cases.
Purpose:
- To describe a novel management approach for unilateral tension pulmonary interstitial emphysema (PIE) in very low birthweight infants.
- To evaluate the efficacy of a tailored ventilation strategy in resolving PIE and improving respiratory parameters.
- To report on the clinical outcomes, including extubation success, in infants treated with this method.
Summary:
- Five very low birthweight infants with unilateral tension PIE were treated with a specific positioning and ventilation strategy.
- This involved positioning the infant on the side affected by PIE, shortening inspiratory time, and in some cases, shortening expiratory time for higher frequency ventilation.
- The treatment led to PIE resolution within 3-6 days, decreased oxygen requirements (FiO2), and reduced peak inspiratory pressures.
Impact:
- This approach offers a potentially effective, non-invasive method for managing unilateral tension PIE in vulnerable neonates.
- Successful resolution of PIE facilitated earlier extubation and improved long-term respiratory outcomes for these infants.
- The findings may inform clinical guidelines for respiratory support in neonates with complex lung conditions.
Abstract:
Five very low birthweight infants manifested unilateral tension pulmonary interstitial emphysema (PIE). All infants required intermittent positive pressure ventilation for respiratory distress syndrome. PIE was managed by positioning the infant on his (or her) side with PIE and by shortening the inspiratory time, in four patients also by shortening exspiratory time resulting in a higher frequency ventilation. PIE resolved within 3-6 days after institution of this treatment. This was paralleled by a reduction of FiO2 as well as peak inspiratory pressures. All infants could successfully be extubated 2-6 weeks after birth.