Department of Pediatric Surgery, Private Safa Hospital, İstanbul, Turkey
Department of Pediatric Surgery, Private Avicenna Hospital, İstanbul, Turkey
Turk J Med Sci. 2021 Jun 28;51(3):1201-1210. doi: 10.3906/sag-2010-286.
BACKGROUND/AIM: Current neonatal pneumothorax classifications based on air volume escaping in pleural space have no contribution on the treatment. Therefore, our aim was to classify neonatal pneumothorax to guide treatment management based on our experiences.
The records of all neonates admitted to our clinics from March 2017 to August 2020 were reviewed. The patients with pneumothorax were identified through the neonatology department patient database search. The study only included the patients with symptomatic pneumothorax and these patients were evaluated into 3 groups based on the changes in peripheral oxygen saturation (SpO2) and clinical features immediately after the tube thoracostomy (TT) procedure. Accordingly, neonatal pneumothorax was divided into 3 types: patients with SpO2 increasing immediately after TT were included in type I, patients whose SpO2 did not change after TT were included in type II, and patients with SpO2 decreasing immediately after TT were included in type III pneumothorax.
A total of 82 patients were included in the study. Sixty-one percent of these patients had type I, 24% had type II, and 15% had type III pneumothorax. None of the neonates died in type I and II pneumothoraces while 9 of 12 neonates (75%) died within the neonatal period in type III pneumothorax. Although we applied treatments such as high-frequency oscillatory ventilation, selective intubation, continuous negative aspiration, and surgical treatment to our patients that were lost due to type III pneumothorax, we were not successful. We successfully managed our surviving type III pneumothorax patients with a simple pressure cycle ventilator, using a combination of high rates, modest peak airway pressures [18 to 22 cm H2O and no positive end-expiratory pressure (PEEP)], and an autologous blood patch.
Classification of pneumothoraces into different types significantly contributes to patient treatment planning through a predetermined strategy, not through trial-and-error. High frequency and zero PEEP ventilation can provide significant improvement in risky cases.
背景/目的：目前基于胸腔内逸出气量的新生儿气胸分类对治疗没有贡献。因此，我们的目的是根据我们的经验对新生儿气胸进行分类，以指导治疗管理。
回顾了 2017 年 3 月至 2020 年 8 月期间我院所有新生儿的住院记录。通过新生儿科患者数据库搜索确定患有气胸的患者。本研究仅包括有症状气胸的患者，并根据经胸腔管引流（TT）术后即刻外周血氧饱和度（SpO2）和临床特征将这些患者分为 3 组。因此，新生儿气胸分为 3 种类型：TT 后即刻 SpO2 升高的患者归入 I 型，TT 后 SpO2 无变化的患者归入 II 型，TT 后即刻 SpO2 下降的患者归入 III 型气胸。
共纳入 82 例患者。其中 61%为 I 型，24%为 II 型，15%为 III 型气胸。I 型和 II 型气胸无一例新生儿死亡，而 III 型气胸中有 9 例（75%）新生儿期死亡。尽管我们对 III 型气胸丢失的患者应用高频振荡通气、选择性插管、持续负压吸引和手术治疗等治疗方法，但均未成功。我们使用简单的压力循环呼吸机，结合高频率、适度的气道峰压[18 至 22cmH2O 且无呼气末正压（PEEP）]，以及自体血贴剂成功地治疗了存活的 III 型气胸患者。
通过预定策略而非反复试验对气胸进行分类，可显著有助于患者的治疗计划。高频和零 PEEP 通气可以为高危病例提供显著改善。
