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Risk factors for Pulmonary Interstitial Emphysema(PIE) in Mechanically Ventilated Neonates with Hyaline Membrane Diseas

Journal of the Korean Pediatric Society 1997;40(3):318-326.
Published online March 15, 1997.
Risk factors for Pulmonary Interstitial Emphysema(PIE) in Mechanically Ventilated Neonates with Hyaline Membrane Diseas
Shin Won Yoon, Chul Lee, Jeong Nyun Kim, Ran Namgung, Dong Gwan Han, Myung Joon Kim
Department of Pediatric, Yonsei University Colledge of Medicine, Seoul, Korea
호흡기치료를 받은 유리질막증 환아에서 폐간질기종의 위험인자에 관한 연구
윤신원, 이철, 김정년, 남궁란, 한동관, 김명준
연세대학교 의과대학 소아과학교실
Abstract
Purpose
: Pulmonary interstitial emphysema(PIE) is a common and serious complication of mechanical ventilation in infants with hyaline membrane disease. This abnormal collection of gases has two basic roentgenographic features; linear and cyst-like radiolucencies. High positive inspiratory pressure was found to be the most significant parameter associated with development of fatal pulmonary interstitial emphysema. Without prompt conservative management such as lowering peak inspiratory pressure, PIE often progress to a pneumothorax with increased mortality. We studied the incidence and risk factors of PIE and associated risk factors which progress to pneumothorax in mechanically ventilated infants with hyaline membrane disease.
Methods
: We reviewed retrospectively the charts of infants who had been admitted to the neonatal intensive care unit between Jan.1990 and Mar.1995.A hundred and two infants who were diagnosed as hyaline membrane disease and mechanically ventilated were included in the study. Analysis of clinical characteristics and ventilator parameters were made. Chest radiographs were reviewed for hyaline membrane disease, PIE, pneumothorax by a pediatric radiologist without knowledge of their clinical course.
Results
: 1) We observed PIE in 14 of102 infants(13.7%) of which 11 infants progressed to developpneumothorax. 2) Low gestational age, low apgar score and high peak inspiratory pressure were the factors significantly associated with development of PIE. 3) PIE was frequently located bilaterally(52%), distributed on whole lung parenchyme (92%). Sizes of radiolucency were variable including blebs. 4) Early onset PIE and failure to promptly lower peak inspiratory pressure were the associated risk factors for development of pneumothorax. 5) Pneumothorax developed within a mean 7.5 hours after apperance of PIE. Right side pneumothorax was more frequent(67%). Mortality increased to 73% with development of pneumothorax in PIE.
Conclusion
: Early diagnosis of PIE and prompt lowering of peak inspiratory pressure should be emphasized to improve the survival and outcome of mechanically ventilated hyaline membrane diasease infants.
Key Words: Hyaline membrane disease, Pulmonary interstitial emphysema, Pneumothora


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