Lee Shing-Yan Robert
Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.
AJP Rep. 2017 Apr;7(2):e101-e105. doi: 10.1055/s-0037-1603322.
In the treatment of left-sided pulmonary interstitial emphysema (PIE) in a 23-week neonate, we used two ventilatory strategies: selective bronchial intubation from day 10 to 15 and neurally adjusted ventilatory assist (NAVA) from day 18 to 26. We compared the effects and adverse effects of these two strategies. On selective bronchial intubation, desaturation was frequent. Fentanyl infusion was required. There was an episode of carbon dioxide retention coupled with hypotension. On NAVA, the neonate was clinically stable without the requirement of sedation. On selective bronchial intubation, ventilator setting in terms of mean airway pressure and oxygen requirement was higher, which came down on the first day of NAVA. Radiologically unilateral PIE did not resolve and became localized in the left middle zone of lung field on selective bronchial intubation. Also, the lobar collapse of ipsilateral, as well as contralateral lungs occurred. On NAVA, unilateral PIE resolved. NAVA might be a good option for the management of unilateral PIE.
在治疗一名23周龄新生儿的左侧肺间质肺气肿（PIE）时，我们采用了两种通气策略：从第10天至第15天进行选择性支气管插管，从第18天至第26天采用神经调节通气辅助（NAVA）。我们比较了这两种策略的效果和不良反应。在选择性支气管插管时，频繁出现血氧饱和度下降。需要输注芬太尼。有一次二氧化碳潴留并伴有低血压。在使用NAVA时，新生儿临床稳定，无需镇静。在选择性支气管插管时，平均气道压力和氧气需求方面的呼吸机设置较高，在开始使用NAVA的第一天有所下降。在选择性支气管插管时，影像学上单侧PIE未缓解，并局限于肺野的左中区。此外，同侧及对侧肺叶出现萎陷。在使用NAVA时，单侧PIE得到缓解。NAVA可能是管理单侧PIE的一个良好选择。
