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Pulmonary interstitial emphysema
Insights
Pulmonary interstitial emphysema in preterm infants is linked to endotracheal tube malposition and high-pressure ventilation. While it increases complications, it does not raise mortality rates.
Area of Science:
- Neonatal Medicine
- Pediatric Respiratory Medicine
- Medical Imaging
Background:
- Respiratory distress syndrome (RDS) is a common condition in preterm infants.
- Mechanical ventilation is often required for RDS, but can lead to complications.
- Pulmonary interstitial emphysema (PIE) is a known complication of mechanical ventilation in neonates.
Purpose of the Study:
- To investigate the incidence and risk factors of pulmonary interstitial emphysema (PIE) in preterm infants with RDS.
- To determine the association between PIE and other complications, including pneumothorax, intraventricular hemorrhage, and mortality.
- To evaluate the effect of fast rate ventilation on PIE and associated outcomes.
Main Methods:
- Retrospective analysis of 210 preterm infants with RDS requiring mechanical ventilation over three years.
- Radiological assessment for evidence of PIE.
- Correlation analysis to identify associations between ventilation parameters, endotracheal tube position, and PIE development and outcomes.
Main Results:
- Forty-one infants (19.5%) developed PIE.
- PIE was significantly associated with endotracheal tube malpositioning and high peak pressure ventilation.
- PIE correlated with increased pneumothoraces, intraventricular hemorrhages, and prolonged respiratory support, but not mortality.
- Fast rate ventilation in 12 infants reduced pneumothoraces but did not alter other outcomes.
Conclusions:
- Endotracheal tube malposition and high peak pressure ventilation are significant risk factors for PIE in preterm infants with RDS.
- PIE is associated with increased morbidity but not mortality.
- Fast rate ventilation may help reduce pneumothoraces, potentially offering greater benefit if implemented before PIE onset.
Abstract:
Forty one of 210 preterm infants ventilated for respiratory distress syndrome in a three year period had radiological evidence of pulmonary interstitial emphysema. The development of this condition was significantly associated with malpositioning of the endotracheal tube in a main bronchus and the use of high peak pressure ventilation. Pulmonary interstitial emphysema was associated with a significant increase in the number of pneumothoraces, intraventricular haemorrhages, and the need for prolonged respiratory support, but did not increase mortality. Although in 12 infants in whom fast rate ventilation was used there was a significant reduction in the number of pneumothoraces, outcome was not altered in any other way. Fast rate ventilation may be of greater benefit if initiated before the development of pulmonary interstitial emphysema.