M Watkinson1, I Tiron. 1. Neonatal Unit, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK. watkinm@heartsol.wmids.nhs.uk
Abstract
AIM: To examine the relation of overventilation and other clinical events to the development of pneumothoraces in ventilated neonates. METHODS: A case-control study. RESULTS: Fifty three (8.7%) of 606 ventilated neonates developed a pneumothorax. Eighteen (34%) cases and 23 (43%) controls were unintentionally overventilated (PaCO(2) < 4 kPa) at some time before the pneumothorax developed in the cases (odds ratio (OR) = 0.78, 95% confidence interval (CI) 0.48 to 1.27). In the three hours before the diagnosis of pneumothorax, more cases than controls were reintubated (21/53 v 4/53; OR = 5.25, 95% CI 1.9 to 14.3), and also in seven cases (one control) the mean airway pressure was increased, whereas in nine controls (no cases) it was reduced (chi(2) = 12.0, df = 2, p = 0.001). Seven of 18 neonates diagnosed by transillumination had undergone no clinical procedures before diagnosis compared with five of 35 diagnosed radiologically (OR = 2.7, 95% CI 1.0 to 7.4). CONCLUSIONS: Unintentional overventilation was not associated with pneumothoraces. In the hours before diagnosis, there was increased clinical intervention, including reintubation; this was less so in those diagnosed by transillumination. The study did not elucidate whether such interventions caused the pneumothorax or were secondary to a failure to diagnose it.
AIM: To examine the relation of overventilation and other clinical events to the development of pneumothoraces in ventilated neonates. METHODS: A case-control study. RESULTS: Fifty three (8.7%) of 606 ventilated neonates developed a pneumothorax. Eighteen (34%) cases and 23 (43%) controls were unintentionally overventilated (PaCO(2) < 4 kPa) at some time before the pneumothorax developed in the cases (odds ratio (OR) = 0.78, 95% confidence interval (CI) 0.48 to 1.27). In the three hours before the diagnosis of pneumothorax, more cases than controls were reintubated (21/53 v 4/53; OR = 5.25, 95% CI 1.9 to 14.3), and also in seven cases (one control) the mean airway pressure was increased, whereas in nine controls (no cases) it was reduced (chi(2) = 12.0, df = 2, p = 0.001). Seven of 18 neonates diagnosed by transillumination had undergone no clinical procedures before diagnosis compared with five of 35 diagnosed radiologically (OR = 2.7, 95% CI 1.0 to 7.4). CONCLUSIONS: Unintentional overventilation was not associated with pneumothoraces. In the hours before diagnosis, there was increased clinical intervention, including reintubation; this was less so in those diagnosed by transillumination. The study did not elucidate whether such interventions caused the pneumothorax or were secondary to a failure to diagnose it.
Authors: Dan Waisman; Anna Faingersh; Carmit Levy; Eugene Konyukhov; Fatmi Ifat Colman Klotzman; Avi Rotschild; Amir Landesberg Journal: Intensive Care Med Date: 2011-11-22 Impact factor: 17.440
Authors: Dan Waisman; Carmit Levy; Anna Faingersh; Fatmi Ifat Colman Klotzman; Eugene Konyukhov; Irena Kessel; Avi Rotschild; Amir Landesberg Journal: Intensive Care Med Date: 2011-04-29 Impact factor: 17.440
Authors: Dan Waisman; Anna Faingersh; Carmit Levy; Ifat Colman-Klotzman; Avi Rotschild; Oscar Lichtenstein; Amir Landesberg Journal: Intensive Care Med Date: 2012-11-21 Impact factor: 17.440