Arterial blood gas and expiratory pressure monitoring in infants with pneumothorax: prognostic predictability.

Infants presenting with pneumothorax within the first 24 hours of life were studied in an attempt to produce a reliable index of the severity of the disease. Of these 54 patients, 46 infants required intubation and ventilator support; 18 (39%) survived and 28 (61%) died. Overall mortality in this series was 52%. We have been able to define clearly the two groups (survivors and nonsurvivors) based on their response to ventilatory parameters. The nonsurvivor group displayed CO2 retention associated with pneumopericardium and pulmonary interstitial emphysema. This group was unresponsive to high fraction of inspired oxygen and high positive end expiratory pressure. The survivor group responded well to a fraction of inspired oxygen of less than 70% and a positive end expiratory pressure of 6 cm or less. Arterial CO2, pneumopericardium, pulmonary interstitial emphysema, pneumomediastinum, and birthweight are useful in predicting the severity of the respiratory distress in these infants and in evaluating the nonsurvivors from the survivors.