%0 Journal Article
%T Frequency and Intensive Care Related Risk Factors of Pneumothorax in Ventilated Neonates
%A Ramesh Bhat Yellanthoor
%A Vidya Ramdas
%J Pulmonary Medicine
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/727323
%X Objectives. Relationships of mechanical ventilation to pneumothorax in neonates and care procedures in particular are rarely studied. We aimed to evaluate the relationship of selected ventilator variables and risk events to pneumothorax. Methods. Pneumothorax was defined as accumulation of air in pleural cavity as confirmed by chest radiograph. Relationship of ventilator mode, selected settings, and risk procedures prior to detection of pneumothorax was studied using matched controls. Results. Of 540 neonates receiving mechanical ventilation, 10 (1.85%) were found to have pneumothorax. Respiratory distress syndrome, meconium aspiration syndrome, and pneumonia were the underlying lung pathology. Pneumothorax mostly (80%) occurred within 48 hours of life. Among ventilated neonates, significantly higher percentage with pneumothorax received mandatory ventilation than controls (70% versus 20%; ). Peak inspiratory pressure >20£¿cm and overventilation were not significantly associated with pneumothorax. More cases than controls underwent care procedures in the preceding 3 hours of pneumothorax event. Mean airway pressure change ( ) and endotracheal suctioning ( ) were not significantly associated with pneumothorax. Reintubation ( ), and bagging ( ) were significantly associated with pneumothorax. Conclusion. Pneumothorax among ventilated neonates occurred at low frequency. Mandatory ventilation and selected care procedures in the preceding 3 hours had significant association. 1. Introduction Pneumothorax is the most common air-leak syndrome resulting in significant morbidity and mortality in neonates [1¨C3]. Increased mortality and chronic lung disease with pneumothorax (about 13 times) in very low birth weight (VLBW) neonates have been reported by Powers and Clemens [3]. Its relationship with underlying primary lung disorders is well recognized [1, 4, 5]. However, higher incidences of pneumothorax in ventilated neonates [3¨C5] with mild increase among those receiving continuous positive airway pressure (CPAP) and dramatic increase with mandatory modes of ventilation have been addressed by only few studies [1, 4]. Similarly studies addressing association of pneumothorax to various ventilation strategies are scarce. Such strategies with high incidence of pneumothorax include high peak inspiratory pressure (PIP) and mean airway pressure (MAP), active expiratory reflex, administration of bag and mask ventilation, endotracheal tube displacement, an increase in clinical interventions [6¨C9], long inspiratory time [10], and high frequency ventilation [11]. Ventilator
%U http://www.hindawi.com/journals/pm/2014/727323/