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Pneumothorax and pneumomediastinum during pediatric mechanical ventilation
Insights
Pediatric mechanical ventilation can cause pulmonary barotrauma, including pneumothorax, especially in young infants after surgery. High positive end-expiratory pressure (PEEP) significantly increases this risk in children.
Area of Science:
- Pediatric critical care medicine
- Respiratory physiology
- Thoracic surgery complications
Background:
- Pulmonary barotrauma is a known complication of mechanical ventilation.
- Data on its incidence in pediatric patients beyond the neonatal period is limited.
- Understanding risk factors is crucial for preventing adverse outcomes.
Purpose of the Study:
- To determine the incidence of pulmonary barotrauma (pneumothorax, pneumomediastinum) in pediatric patients receiving mechanical ventilation.
- To identify risk factors associated with these complications.
- To compare incidence rates with adult populations.
Main Methods:
- Retrospective analysis of 179 pediatric patients ventilated for over 12 hours.
- Analysis of 14 patients ventilated with positive end-expiratory pressure (PEEP) ≥ 15 cm H2O.
- Categorization by age (0-6 months vs. >6 months) and underlying conditions.
Main Results:
- Young infants (0-6 months) without hyaline membrane disease had an 11% incidence of barotrauma post-cardiothoracic surgery.
- Older infants/children (>6 months) with severe respiratory disease had a 3% incidence.
- In patients with PEEP ≥ 15 cm H2O, the overall incidence was 64%, with 43% developing pneumothorax.
- Prolonged PEEP (>24 hours) further increased barotrauma risk.
Conclusions:
- Pulmonary barotrauma incidence in ventilated children without hyaline membrane disease is comparable to adult series.
- Young infants undergoing cardiothoracic surgery are at higher risk.
- High PEEP levels are a significant risk factor for barotrauma in pediatric patients.
Abstract:
The incidence of pulmonary barotrauma during mechanical ventilation in children beyond the neonatal age group was studied in two groups of patients. In the first group, 179 cases of pediatric mechanical ventilation for over 12 hours were retrospectively analyzed for the occurrence of pneumothorax and pneumomediastrinum. Eleven percent (6 of 57) of young infants (0--6 months) without hyaline membrane disease and 3% (4 of 122) of older infants and children (over 6 months) developed these complications. Pulmonary barotrauma in young infants occurred only after cardiothoracic surgery and involved the same site as the intraoperative repair in all cases. Pulmonary barotrauma in older infants and children occurred in patients with severe respiratory disease requiring high peak airway pressures, PEEP, and respiratory rates. In the second group, the incidence of pulmonary barotrauma during ventilation with PEEP greater than or equal to 15 cm H2O was analyzed in 14 patients including 4 patients from the previous group. Overall, 64% (9 of 14) of this group developed pulmonary barotrauma and 43% (6 of 14) developed pneumothorax. Of 9 patients receiving PEEP greater than or equal to 15 cm H2O for longer than 24 hours, 6 developed pulmonary barotrauma after the first 24 hours. The incidence of pneumothorax and pneumomediastinum in ventilated infants without hyaline membrane disease and children is comparable to adult series.