Abstract
The increased occurrence of pulmonary interstitial emphysema, pneumothorax, pneumomediastinum, and pneumopericardium during mechanical ventilation is well known. However, the mechanical relationships during ventilation between time, pressure and neonatal airleak syndrome (NAS) are poorly understood. 13 of 56 infants (23%) ventilated with pressure-cycled ventilators (Bournes BP200 set to deliver a square respiratory wave form) developed roentgenographic findings of NAS. 13 similarly ventilated infants (controls) who did not develop NAS were matched with the NAS patients for birth weight (x=1485), gestational age (x=31 wk), initial mean airway pressure (Paw) and initial alveolar-to-arterial gradient (A-aDO2). Infants who developed NAS had positive changes in Paw (+ΔPaw) until 60 hr of life, while controls showed -ΔPaw after 12 hr of life. The ΔPaw for NAS patients in the first 24 hr of life was +3.5 cm H2O vs -0.4 cm H2O for controls (t=2.76, p<0.02). Average Paw for 108 hr was 11.9 cm H2O ± 1.0 SEM for airleak infants vs 8.3 cm H2O (t=3.0, p<0.01). We conclude: 1) infants who develop NAS while undergoing pressure-cycled ventilation receive significantly higher Paw than infants without NAS, and 2) the increase in Paw during the first 24 hr of ventilation is more rapid in infants who develop NAS; therefore, we anticipate an airleak if the Paw must be increased more than 3.5 cm H2O in first day of mechanical ventilation.
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Litzenberger, M., Cunningham, H., Desai, N. et al. 1686 CHANGES IN MEAN AIRWAY PRESSURE: SIGNIFICANCE IN NEONATAL AIRLEAK SYNDROME. Pediatr Res 15 (Suppl 4), 724 (1981). https://doi.org/10.1203/00006450-198104001-01705
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DOI: https://doi.org/10.1203/00006450-198104001-01705