Pneumothorax in a "stable"ventilated infant .Immediate chest tube or wait and see ??

[Leonora DEsposito]

:confused:
This is about a 2 days old baby 36weeks,delivered by C section. Mother with urinary infection.
Dx with Pneumonia. Developed respiratory distress,managed with Survanta plus nasal CPAP.
X rays with Pneumothorax.Evacuated by needle puncture .(32cc of air ).
Persistent distress,intubated and with mechanical ventilation improved.
New X rays with 30 % ?? pneumothorax .Attending decided not to place chest tube.
Big controversy..I would like to hear your opinion in this case. Regards .

[Stefan Johansson]

Could you upload an x-ray?
It is hard to say but it seems plausible that the pneumo contributes to the respiratory distress.
You could try to evacuate the pneumo once again with a needle. If air returns on x-ray, you def have a leak which probably needs to heal under drainage.

[urai06]

I would like to see CXR too.I have experience for pneumothorax and do not on chest tube by using CPAP instead of ventilator ith 100% Oxygen.
Uraiwan

[Leonora DEsposito]

Dear colleagues .I'm sorry ,but I can't upload the X rays. In the middle of this case we experienced problems with Radiology.Poor quality films.:(
Case update: baby doing better,no pneumothorax today.Ready for CPAP.Thanks for your opinion.:)

[Stefan Johansson]

Happy ending then!
Glad to hear that you managed your case with a conservative strategy.
General comment: aggressive active strategies are is always easy, sometimes they are not necessary.

[dask]

:confused:
This is about a 2 days old baby 36weeks,delivered by C section. Mother with urinary infection.
Dx with Pneumonia. Developed respiratory distress,managed with Survanta plus nasal CPAP.
X rays with Pneumothorax.Evacuated by needle puncture .(32cc of air ).
Persistent distress,intubated and with mechanical ventilation improved.
New X rays with 30 % ?? pneumothorax .Attending decided not to place chest tube.
Big controversy..I would like to hear your opinion in this case. Regards .

[urai06]

We can extubate the patient if patient can on low CPAP and can breath well, not distress with high FiO2.
uraiwn

[KBOUDHARHCA]

The CPAP nasal are contribuate to product the pneumothorax, Intubated favorise the pneumothorax.
FiO2 at 100% is indicated.
If the pneumothorax is installeted with méchanical ventilation + PIP hight 25, place tube is indicated.

[JACK]

FiO2 at 100% is indicated.
.

100% FiO2 is no longer recommended

Sola A, Saldeño YP, Favareto V. Clinical practices in neonatal oxygenation:
where have we failed? What can we do? J Perinatol. 2008 May;28 Suppl 1:S28-34.
Review. PubMed PMID: 18446174.
LINK to DOWNLOAD (http://www.nature.com/jp/journal/v28/n1s/pdf/jp200847a.pdf)

[KBOUDHARHCA]

100% FiO2 is no longer recommended

is recommended for full term newborn during short period

[nashwa]

i want your openion about fistula falsely introduced by chest tube