Events before the diagnosis of a pneumothorax in ventilated neonates

Abstract

AIM To examine the relation of overventilation and other clinical events to the development of pneumothoraces in ventilated neonates. METHODS A case-control study. RESULTS Fifty three (8.7%) of 606 ventilated neonates developed a pneumothorax. Eighteen (34%) cases and 23 (43%) controls were unintentionally overventilated (Pa co 2 < 4 kPa) at some time before the pneumothorax developed in the cases (odds ratio (OR) = 0.78, 95% confidence interval (CI) 0.48 to 1.27). In the three hours before the diagnosis of pneumothorax, more cases than controls were reintubated (21/53 v 4/53; OR = 5.25, 95% CI 1.9 to 14.3), and also in seven cases (one control) the mean airway pressure was increased, whereas in nine controls (no cases) it was reduced (χ 2 = 12.0, df = 2, p = 0.001). Seven of 18 neonates diagnosed by transillumination had undergone no clinical procedures before diagnosis compared with five of 35 diagnosed radiologically (OR = 2.7, 95% CI 1.0 to 7.4). CONCLUSIONS Unintentional overventilation was not associated with pneumothoraces. In the hours before diagnosis, there was increased clinical intervention, including reintubation; this was less so in those diagnosed by transillumination. The study did not elucidate whether such interventions caused the pneumothorax or were secondary to a failure to diagnose it. Key messages Brief inadvertent overventilation was not associated with pneumothoraces There was a cluster of clinical procedures before the diagnosis of a pneumothorax. This included reintubation and increases in airway pressure. This study did not establish whether these procedures caused pneumothoraces or were undertaken because an undiagnosed pneumothorax was already causing clinical deterioration.