Kurimoto Tomonori, Tokuhisa Takuya, Yara Asataro, Kibe Masaya, Ohashi Hiroshi, Yamamoto Masakatsu, Yamamoto Tsuyoshi, Hirakawa Eiji
Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, 37-1 Uearata, Kagoshima 890-8760, Japan.
Resusc Plus. 2025 Apr 8;23:100954. doi: 10.1016/j.resplu.2025.100954. eCollection 2025 May.
Extremely preterm infants (22-24 weeks of gestation) are at high risk of tension pneumothorax, a life-threatening condition that causes haemodynamic instability. This study aimed to analyse the haemodynamic changes associated with tension pneumothorax and identify the mean airway pressure (MAP) threshold associated with its onset.
This retrospective descriptive study was conducted in a Level III Neonatal Intensive Care Unit (NICU) (2014-2024). Infants born between 22 + 0 to 24 + 6 weeks of gestation who developed tension pneumothorax within 72 h of birth were included. Haemodynamic parameters, including central venous pressure (CVP), mean arterial pressure (mBP), heart rate (HR), saturation of percutaneous oxygen (SpO), fraction of inspired oxygen (FiO), and MAP, were analysed at baseline, pneumothorax onset, and post-decompression. Statistical analyses included the Wilcoxon signed-rank test and generalised linear mixed model (GLMM).
The CVP significantly increased at the onset of pneumothorax ( = 0.004) and decreased post-intervention ( = 0.004). The mBP and HR declined at onset ( = 0.0005) and partially recovered post-intervention. MAP was significantly higher at onset ( = 0.003), and GLMM analysis showed that an MAP increase of ≥1.3 cmHO was associated with pneumothorax risk.
A sudden increase in CVP may serve as an early indicator of tension pneumothorax. An MAP threshold of ≥12 cmHO was linked to higher pneumothorax risk, emphasising the need for cautious ventilatory management. Persistent haemodynamic instability after decompression highlights the need for close monitoring. Further studies are required to refine the neonatal care strategies.
极早产儿（妊娠22 - 24周）发生张力性气胸的风险很高，这是一种危及生命的疾病，可导致血流动力学不稳定。本研究旨在分析与张力性气胸相关的血流动力学变化，并确定与其发生相关的平均气道压（MAP）阈值。
本回顾性描述性研究在一家三级新生儿重症监护病房（NICU）（2014 - 2024年）进行。纳入出生孕周在22 + 0至24 + 6周之间、出生后72小时内发生张力性气胸的婴儿。分析基线、气胸发作时和减压后的血流动力学参数，包括中心静脉压（CVP）、平均动脉压（mBP）、心率（HR）、经皮血氧饱和度（SpO）、吸入氧分数（FiO）和MAP。统计分析包括Wilcoxon符号秩检验和广义线性混合模型（GLMM）。
气胸发作时CVP显著升高（P = 0.004），干预后降低（P = 0.004）。mBP和HR在发作时下降（P = 0.0005），干预后部分恢复。发作时MAP显著更高（P = 0.003），GLMM分析显示MAP升高≥1.3 cmH₂O与气胸风险相关。
CVP突然升高可能是张力性气胸的早期指标；MAP阈值≥12 cmH₂O与较高的气胸风险相关，强调谨慎的通气管理的必要性。减压后持续的血流动力学不稳定突出了密切监测的必要性。需要进一步研究以完善新生儿护理策略。
