Pneumomediastinum in the Neonate

2014 ◽  
Vol 33 (5) ◽  
pp. 275-282 ◽  
Author(s):  
Kristi J. Cagle ◽  
Carol Trotter
Keyword(s):  
Air Leak ◽  
Air Leaks ◽  
Radiologic Findings ◽  
Free Air

A pneumomediastinum is an air leak in which the free air is concentrated in the mediastinum. Although most neonatal pneumomediastinums do not require intervention, complications such as subsequent air leaks can arise. Proper radiologic identification, as well as an understanding of the anatomy and pathophysiology associated with a pneumomediastinum, are necessary for an accurate understanding and diagnosis. This article will review the interpretation of radiologic findings in a neonate with a pneumomediastinum.

Management of Persistent Air Leaks with Intrabronchial Valves

2017 ◽  
Vol 66 (07) ◽  
pp. 603-606
Author(s):  
Andreas Hecker ◽  
Konstantin Mayer ◽  
Biruta Witte ◽  
Matthias Hecker
Keyword(s):  
Thoracic Surgery ◽  
Minimal Invasive ◽  
Therapeutic Approaches ◽  
Air Leak ◽  
Frequent Complication ◽  
Less Invasive ◽  
Air Leaks ◽  
Prolonged Hospitalization ◽  
Highly Effective ◽  
Endoscopic Placement

AbstractPersistent air leaks (PALs) are regarded as a frequent complication after thoracic surgery resulting in prolonged hospitalization and increased morbidity. Several more or less invasive therapeutic approaches are available for treatment of PAL with varying degrees of success. The endoscopic placement of one-way intrabronchial valves in the segment(s) in which the air leak has been located offers a highly effective and well-tolerated minimal invasive option for patients with PAL.

scholarly journals Intrabronchial Valve Treatment for Prolonged Air Leak: Can We Justify the Cost?

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Eitan Podgaetz ◽  
Felix Zamora ◽  
Heidi Gibson ◽  
Rafael S. Andrade ◽  
Eric Hall ◽  
...  
Keyword(s):  
Individual Patient Data ◽  
Cost Effective ◽  
Air Leak ◽  
Levels Of Care ◽  
Air Leaks ◽  
Limited Experience ◽  
Tube Removal ◽  
Prolonged Air Leak ◽  
Chest Tube Removal ◽  
The Cost

Background.Prolonged air leak is defined as an ongoing air leak for more than 5 days. Intrabronchial valve (IBV) treatment is approved for the treatment of air leaks.Objective.To analyze our experience with IBV and valuate its cost-effectiveness.Methods.Retrospective analysis of IBV from June 2013 to October 2014. We analyzed direct costs based on hospital and operating room charges. We used average costs in US dollars for the analysis not individual patient data.Results.We treated 13 patients (9 M/4 F), median age of 60 years (38 to 90). Median time from diagnosis to IBV placement was 9.8 days, time from IBV placement to chest tube removal was 3 days, and time from IBV placement to hospital discharge was 4 days. Average room and board costs were $14,605 including all levels of care. IBV cost is $2750 per valve. The average number of valves used was 4. Total cost of procedure, valves, and hospital stay until discharge was $13,900.Conclusion.In our limited experience, the use of IBV to treat prolonged air leaks is safe and appears cost-effective. In pure financial terms, the cost seems justified for any air leak predicted to last greater than 8 days.

scholarly journals Air Leak Syndrome: Pneumoperitoneum in a Ventilated Neonate

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Chandana Ravikumar ◽  
Dawn McDaniel ◽  
Amy Quinn
Keyword(s):  
Intestinal Perforation ◽  
Clinical Evidence ◽  
Meconium Aspiration Syndrome ◽  
Term Neonate ◽  
Air Leak ◽  
Air Trapping ◽  
Meconium Aspiration ◽  
Common Presentation ◽  
Free Air ◽  
Air Leak Syndrome

Air leak syndrome has several manifestations and is common in neonates with meconium aspiration syndrome (MAS) due to air trapping. While pneumoperitoneum is classically a result of intestinal perforation, intra-abdominal free air may be a less common presentation of air leak syndrome. In the ventilated neonate, there is insufficient clinical evidence outlining management of pneumoperitoneum in this situation. We report a case of a term neonate with MAS and air leak syndrome who developed benign pneumoperitoneum (BPPT).

scholarly journals THE BENEFITS OF RECORDING AIR LEAKS WITH GRAPHIC REPRESENTATION EXPERIENCE WITH A DIGITAL AIR LEAK DRAINAGE SYSTEM

CHEST Journal ◽  
2008 ◽  
Vol 134 (4) ◽  
pp. 82P
Author(s):  
Cosimo Lequaglie ◽  
Daniela Marasco ◽  
Gabriella Giudice ◽  
Margherita Garramone
Keyword(s):  
Drainage System ◽  
Graphic Representation ◽  
Air Leak ◽  
Air Leaks

scholarly journals Use of endo-bronchial end-tidal CO2 test for location of the pleural air leakage in patients with intractable pneumothorax

2018 ◽  
Vol 12 ◽  
pp. 175346581875656
Author(s):  
Yi-Ming Zeng ◽  
Yun-Feng Chen ◽  
Hui-Huang Lin ◽  
Xiao-Bin Zhang
Keyword(s):  
Confidence Interval ◽  
Main Bronchus ◽  
Balloon Occlusion ◽  
Air Leakage ◽  
Air Leak ◽  
Occlusion Test ◽  
Air Leaks ◽  
Balloon Occlusion Test ◽  
End Tidal ◽  
End Tidal Co2

Background: Location of the affected bronchus of pleural air leaks is the most important step of trans-bronchoscopic bronchial occlusion for the treatment of intractable pneumothorax. The balloon occlusion test is the most commonly used technique, but has failed in some cases. The aim of the present study was: (1) to determine if endo-bronchial end-tidal CO2 (EtCO2) measurement can identify the affected bronchus that is the source of a persistent pleural air leak; and (2) to establish a methodology for endo-bronchial EtCO2 testing in locating affected bronchus in intractable pneumothorax. Methods: A total of 28 patients with intractable pneumothorax underwent bronchoscopy with (1) the balloon occlusion test for the identification of the affected bronchus; and (2) endo-bronchial EtCO2 measurement (EtCO2 test) at the orifices of the bronchus of the affected lung. The effectiveness of these two methods of affected bronchus identification were compared. The threshold EtCO2 (T-EtCO2) was determined. Results: The positive rates of locating the affected bronchus by the endo-bronchial EtCO2 test, balloon occlusion test, and combination of the two techniques were 60.7% (17/28), 64.3% (18/28) and 96.4% (27/28), respectively. The average differences in EtCO2 between the affected bronchus and the main carina, main bronchus, and non-affected bronchus were (in mmHg) 4.41 ± 1.99 (95% confidence interval: 3.5, 5.3), 4.73 ± 2.10 (3.80, 5.66 ) and 5.57 ± 2.53 (4.45, 6.69), respectively. Conclusions: (1) The endo-bronchial EtCO2 test is complementary to the balloon occlusion test of the leading bronchus. (2) A threshold (T-EtCO2) value of >5 mmHg is optimal for this technique.

scholarly journals Complications after Chest Tube Removal and Reinterventions in Patients with Digital Drainage Systems

2019 ◽  
Vol 8 (12) ◽  
pp. 2092
Author(s):  
Yi-Ying Lee ◽  
Po-Kuei Hsu ◽  
Chien-Sheng Huang ◽  
Yu-Chung Wu ◽  
Han-Shui Hsu
Keyword(s):  
Predictive Factors ◽  
Lung Resection ◽  
Drainage System ◽  
Drainage Tube ◽  
Air Leak ◽  
Chest Drainage ◽  
Drainage Systems ◽  
Air Leaks ◽  
Thoracic Drainage ◽  
Tube Removal

Introduction: Digital thoracic drainage systems are a new technology in minimally invasive thoracic surgery. However, the criteria for chest tube removal in digital thoracic drainage systems have never been evaluated. We aim to investigate the incidence and predictive factors of complications and reinterventions after drainage tube removal in patients with a digital drainage system. Method: Patients who received lung resection surgery and had their chest drainage tubes connected with a digital drainage system were retrospectively reviewed. Results: A total of 497 patients were monitored with digital drainage systems after lung resection surgery. A total of 175 (35.2%) patients had air leak-related complications after drainage tube removals, whereas 25 patients (5.0%) required reintervention. We identified that chest drainage duration of five days was an optimal cut-off value in predicting air leak-related complications and reinterventions. In multiple logistic regression analysis, previous chest surgery history; small size (16 Fr.) drainage tubes; the presence of initial air leaks, defined as air leaks recorded by the digital drainage system immediately after operation; and duration of chest drainage ≥5 days were independent factors of air leak-related complications, whereas the presence of initial air leaks and duration of chest drainage ≥5 days were independent predictive factors of reintervention after drainage tube removal. Conclusion: Air leak-related complications and reinterventions after drainage tube removals happened in 35.2% and 5.0% of patients with digital thoracic drainage systems. The management of chest drainage tubes in patients with predictive factors, i.e., the presence of initial air leaks and duration of chest drainage of more than five days, should be treated with caution.

scholarly journals Face Mask Ventilation in Edentulous Patients

2010 ◽  
Vol 112 (5) ◽  
pp. 1190-1193 ◽  
Author(s):  
Stéphane X. Racine ◽  
Audrey Solis ◽  
Nora Ait Hamou ◽  
Philippe Letoumelin ◽  
David L. Hepner ◽  
...  
Keyword(s):  
Standard Method ◽  
Patient Characteristics ◽  
Face Mask ◽  
Positive Pressure ◽  
Mask Ventilation ◽  
Air Leak ◽  
Lower Lip ◽  
Air Leaks ◽  
Edentulous Patients ◽  
Ventilation Method

Background In edentulous patients, it may be difficult to perform face mask ventilation because of inadequate seal with air leaks. Our aim was to ascertain whether the "lower lip" face mask placement, as a new face mask ventilation method, is more effective at reducing air leaks than the standard face mask placement. Methods Forty-nine edentulous patients with inadequate seal and air leak during two-hand positive-pressure ventilation using the ventilator circle system were prospectively evaluated. In the presence of air leaks, defined as a difference of at least 33% between inspired and expired tidal volumes, the mask was placed in a lower lip position by repositioning the caudal end of the mask above the lower lip while maintaining the head in extension. The results are expressed as mean +/- SD or median (25th-75th percentiles). Results Patient characteristics included age (71 +/- 11 yr) and body mass index (24 +/- 4 kg/m2). By using the standard method, the median inspired and expired tidal volumes were 450 ml (400-500 ml) and 0 ml (0-50 ml), respectively, and the median air leak was 400 ml (365-485 ml). After placing the mask in the lower lip position, the median expired tidal volume increased to 400 ml (380-490), and the median air leak decreased to 10 ml (0-20 ml) (P < 0.001 vs. standard method). The lower lip face mask placement with two hands reduced the air leak by 95% (80-100%). Conclusions In edentulous patients with inadequate face mask ventilation, the lower lip face mask placement with two hands markedly reduced the air leak and improved ventilation.

Intraoperative Implementation of a Tissue Sealant on All Lung Surgery Patients: A Quality Improvement Project

2015 ◽  
Vol 8 (1) ◽  
pp. 125-129
Author(s):  
Stephanie Cain ◽  
Richard Anderson ◽  
Patricia Stockert ◽  
Suzanne Brown ◽  
Jane Blood-Siegfried
Keyword(s):  
Length Of Stay ◽  
Chest Tube ◽  
Length Of Hospital Stay ◽  
Clinical Problem ◽  
Hospital Length Of Stay ◽  
Air Leak ◽  
Improvement Project ◽  
Air Leaks ◽  
Pulmonary Surgery ◽  
Tissue Sealant

More than 200,000 patients undergo pulmonary surgery annually. Air leaks after pulmonary surgery are a common complication and represent a substantial clinical problem. Air leaks can increase chest tube time, increase pain, reduce mobility, and increase hospital length of stay. The application of a synthetic surgical lung sealant (SLS) to lung surfaces during surgery in patients at risk for an air leak has been advocated to reduce these complications.The aim of the project was to reduce or eliminate air leaks, decrease chest tube time, and decrease length of stay by applying an FDA-approved tissue sealant during all pulmonary surgeries. The population of focus were adult pulmonary surgery patients undergoing pulmonary surgery.Data were collected on 146 patients: 72 patients the year prior to the intervention and 74 the year after implementation of the intervention. The incidence of air leak was significantly lower; the number of comorbidities was statistically higher in the group following implementation. There were, however, no significant differences in chest tube duration and length of hospital stay. The use of lung sealant on all patients undergoing pulmonary surgery had a positive outcome without any adverse effects and is now standard of practice.

scholarly journals Postoperative Air Leaks With Prompt Improvement of Low Suction on Digital Drainage Devices: a Retrospective Study

2020 ◽  
Author(s):  
Suguru Mitsui ◽  
Shunsuke Tauchi ◽  
Takahiro Uchida ◽  
Hisashi Ohnishi ◽  
Toshio Shimokawa ◽  
...  
Keyword(s):  
Chest Tube ◽  
Pulmonary Resection ◽  
Maximum Amount ◽  
Fluid Volume ◽  
Suction Pressure ◽  
Air Leak ◽  
Air Leaks ◽  
Tube Removal ◽  
Chest Tube Removal ◽  
Pressure Suction

Abstract Purpose: The aim was to investigate the most effective suction pressure for preventing or promptly improving postoperative air leaks.Methods: We retrospectively analyzed the postoperative data of 242 patients who were monitored with a digital drainage system after pulmonary resection between December 2017 and June 2020. We divided the patients into 3 of group by suction pressure, A (Low-pressure suction group: -5 cm H₂O), B (Intermediate-pressure group: -10 cm H₂O), C (High-pressure suction group: -20 cm H₂O). Duration of air leaks, duration of chest tube replacement, the amount of postoperative air leak, fluid volume drained before chest tube removal, and the maximum amount of air leaks during drainage were evaluated.Results: A total 217 patients were included. In the order of A, B, and C groups, duration of air leaks gradually decreased and significant trend was observed (p=0.019). Duration of chest tube replacement did not significantly differ among the three groups (p=0.126). The amount of postoperative air leak just after surgery did not significantly differ among the three groups (p=0.175), however, the amount of postoperative day 1 air leak gradually decreased with statistical significance in order of A, B, and C groups (p=0.033). The maximum amount of air leaks during drainage gradually decreased in order of A, B and C groups (p=0.036). Fluid volume drained before chest tube removal did not significantly differ among the three groups (p=0.986).Conclusion: Low-pressure suction after pulmonary resection would be useful for preventing or promptly improving postoperative air leaks.

scholarly journals APPLICATION OF ENDOBRONCHIAL VALVES IN COMPLICATIONS OF THORACOSCOPIC SURGERY IN PATIENTS WITH BULLOUS EMPHYSEMA OF THE LUNGS

2017 ◽  
Vol 176 (1) ◽  
pp. 20-24
Author(s):  
E. A. Drobyazgin ◽  
Yu. V. Chikinyov ◽  
M. S. Anikina
Keyword(s):  
Local Anesthesia ◽  
Postoperative Period ◽  
Pleural Cavity ◽  
Thoracoscopic Surgery ◽  
Flexible Endoscope ◽  
Air Leakage ◽  
Air Leak ◽  
Air Leaks

The article presents the results of valve bronchoblocation of 20 operated patients with bullous emphysema. These patients had an air leak in the area of drainage from the pleural cavity and lack of unfolding of the lung in postoperative period. All surgeries were performed under local anesthesia. A blocker was placed in the bronchus using flexible endoscope. There weren’t noted any complications during process of blocking. Positive dynamics was observed in the majority (15) patients during the first 3-5 hours after surgery. Venting was decreased on pleural drainages. Positive dynamics such as absence of air leaks on the drainage from the pleural cavity and unfolding of the lung had 17 patients. Drainages were removed from pleural cavity on 3-4 days in case of unfolding of the lung and air leakage absence. The results obtained indicated the possibility of method application in practice of surgical departments.

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