Unresloved Pneumothorax

[drakjaleel]

Hi all i just wanted to share your opinion on this baby
Delivered by emergent CS needed resque SRT for HMD ,initially needed higher ventilator setting for target SPO2 85-90%
Noted labile SPO2,early PPHN started on Silsnafil,MgSo4 ,Ianotropes.
Developed spontaneious tenson pneumothrax- ICD done
Now developed moderate biliiary stasis with thrombocytopenia
Given FFP.PLT concentrate,PCV transfusion for low Hct,partial TPN.
Cranial imaging Grade11 ICH on left parital region
Pneumothrax still not resolved only partial expansion,ICD working well
As of today completed 10th day of ventilation
Parents want to support the infant
Kindly give your suggestions
?kid going for early CLD/PIE what is the further approch
Baby GA 34WKS/SGA
Regards
DrAKJ Ahamed

[JACK]

May try connecting negative suction bottle to continuous suction of 10 cm H2O

Can also try selective intubation and ventilation of the the contralateral lung
Best would be HFOV, if available

[Stefan Johansson]

Once you have resolved atelectasis problems, I'd suggest HFOV with a "low lung volume" strategy to counterbalance PIE development, i.e. reduce pressure as much as possible at the expense of increased FiO2.

[drakjaleel]

Once you have resolved atelectasis problems, I'd suggest HFOV with a "low lung volume" strategy to counterbalance PIE development, i.e. reduce pressure as much as possible at the expense of increased FiO2.

Thank you Jack & Stefan for your valuble suggestion.Greetings and prayers from India for wonderful 2010.
After connecting to icd bottle instead of collapsable bag now lung expanded but CXR showing ? Early CLD started on low dose dexamethazone and frusimide
Now the kid is hemodynamically stable
We don't have true HFOV
We have dual one with CMV/HFO(SLE2000)
Started in minimal trophic feeds thro RT
What else i can do
Regards
Jaleel

[JACK]

Nutrition is the cornerstone of bringing a sick baby out of his illness. Build up his feeds gradually. Good nutrition will make a lot of difference.

Keep a eye out for sepsis - regular blood counts, CRP , Blood C/S

Be careful of using steroids liberally. Can reserve it for later when you feel that you are unable to extubate the baby because of BPD.

Also frusemide may be too strong a diuretic at this stage. It may lead to electrolyte imbalance and toxicity on long term use.
Better would be fluid restriction if you are worried about BPD. If you want a diuretic how about hydroclhorothiazide plus spironolactone ?

[hamakoosha]

ur information are very valuable.. but i want to ask u what about using fio2 100% in cases of pneumothorax???? i dont use it but i know colleagues use it & i cant see a justification... can u help DR Stephan??
much thanks

[JACK]

100% Oxygen is no longer recommended for pneumothorax management.

(Clinical practices in neonatal oxygenation: where have we failed? What can we do?
Journal of Perinatology (2008) 28, S28–S34
LINK TO DOWNLOAD (http://www.nature.com/jp/journal/v28/n1s/pdf/jp200847a.pdf) )