S D Clark1, F Saker1, M T Schneeberger1, E Park2, D W Sutton3, Y Littner1. 1. 1] Department of Neonatology, The Cleveland Clinic Children's, Cleveland Clinic, Cleveland, OH, USA [2] Cleveland Clinic Lerner College of Medicine of Medicine of Case Western Reserve University, Cleveland, OH, USA. 2. 1] Cleveland Clinic Lerner College of Medicine of Medicine of Case Western Reserve University, Cleveland, OH, USA [2] Department of Radiology, The Cleveland Clinic Children's, Cleveland Clinic, Cleveland, OH, USA. 3. 1] Cleveland Clinic Lerner College of Medicine of Medicine of Case Western Reserve University, Cleveland, OH, USA [2] Respiratory Therapy, The Cleveland Clinic Children's, Cleveland Clinic, Cleveland, OH, USA.
Abstract
OBJECTIVE: To compare the effectiveness of 100% oxygen therapy vs oxygen treatment with targeted pulse oximetry in the management of symptomatic small to moderate spontaneous pneumothorax (SP). In total, 100% oxygen treatment for SP has been a common practice in neonatology, albeit there is little evidence to validate its efficacy. STUDY DESIGN: A retrospective chart review of 83 neonatal records with the diagnosis of pneumothorax was conducted. Infants <35 weeks gestation, those with large pneumothoraces requiring chest tube drainage and/or ventilatory support were excluded. Data gathered included demographics, vital signs, treatment information and clinical indicators of resolution of symptoms. RESULT: In total, 45 neonates with SP were included in the study. Groups were similar for gestational age, birth weight, Apgar scores, gravidity, parity, gender, race, pneumothorax size and location. Patients in the 100% oxygen therapy group received a significantly longer oxygen treatment (21.3 vs 8 h, P < 0.001), required longer intravenous fluid treatment (48.6 ± 29.9 vs 31.3 ± 18.8 h, P = 0.03) and were delayed in reaching full feeds (44.1 ± 25.7 vs 29.5 ± 18.8 h, P = 0.03) compared with the oxygen-targeted treatment group. Time to first oral feeding, time to resolution of tachypnea and length of stay were similar in both groups. CONCLUSION: There are no clinically significant advantages to using 100% oxygen in the treatment of symptomatic small to moderate SP. In fact, it may result in longer exposure to unnecessary oxygen treatment and toxicity. Oxygen should be reserved for those who are hypoxic and adjusted to comply with accepted saturation levels in neonates.
OBJECTIVE: To compare the effectiveness of 100% oxygen therapy vs oxygen treatment with targeted pulse oximetry in the management of symptomatic small to moderate spontaneous pneumothorax (SP). In total, 100% oxygen treatment for SP has been a common practice in neonatology, albeit there is little evidence to validate its efficacy. STUDY DESIGN: A retrospective chart review of 83 neonatal records with the diagnosis of pneumothorax was conducted. Infants <35 weeks gestation, those with large pneumothoraces requiring chest tube drainage and/or ventilatory support were excluded. Data gathered included demographics, vital signs, treatment information and clinical indicators of resolution of symptoms. RESULT: In total, 45 neonates with SP were included in the study. Groups were similar for gestational age, birth weight, Apgar scores, gravidity, parity, gender, race, pneumothorax size and location. Patients in the 100% oxygen therapy group received a significantly longer oxygen treatment (21.3 vs 8 h, P < 0.001), required longer intravenous fluid treatment (48.6 ± 29.9 vs 31.3 ± 18.8 h, P = 0.03) and were delayed in reaching full feeds (44.1 ± 25.7 vs 29.5 ± 18.8 h, P = 0.03) compared with the oxygen-targeted treatment group. Time to first oral feeding, time to resolution of tachypnea and length of stay were similar in both groups. CONCLUSION: There are no clinically significant advantages to using 100% oxygen in the treatment of symptomatic small to moderate SP. In fact, it may result in longer exposure to unnecessary oxygen treatment and toxicity. Oxygen should be reserved for those who are hypoxic and adjusted to comply with accepted saturation levels in neonates.
Authors: Khalil Al Tawil; Faisal M Abu-Ekteish; Omar Tamimi; Muneef M Al Hathal; Khalid Al Hathlol; Bdeir Abu Laimun Journal: Pediatr Pulmonol Date: 2004-05