Neonatal pneumothorax in congenital diaphragmatic hernia:Be wary of high ventilatory pressures
作者机构：Pediatric SurgeryUniversity of MichiganAnn ArborMichiganUSA Section of NeonatologyDepartment of PediatricsUniversity of MichiganAnn ArborMichiganUSA Department of SurgeryUniversity of MichiganAnn ArborMichiganUSA
出 版 物：《World Journal of Pediatric Surgery》 (世界小儿外科杂志（英文）)
年 卷 期：2022年第5卷第3期
页 面：154-161页
学科分类：1002[医学-临床医学] 100202[医学-儿科学] 10[医学]
主 题：PEEP pneumothorax diagnosis
摘 要：Background Patients with congenital diaphragmatic hernia(CDH)require invasive respiratory support and higher ventilator pressures may be associated with *** sought to evaluate the risk factors associated with pneumothorax in CDH neonates prior to *** Weretrospectivelyreviewednewborns born withCDHbetween 2014and 2019who developeda pneumothorax,and we matched these cases to patients with CDH without *** Twenty-sixpatientswere included(n=13per group).The pneumothorax group required extracorporeal life support(ECLS)more frequently(85%vs 54%,p=0.04),particularly among type A/B defects(31%vs 7%,p=0.01).The pneumothorax group had higher positive end-expiratory pressure(PEEP)within 1 hour of birth(p=0.02),at pneumothorax diagnosis(p=0.003),and at ECLS(p=0.02).The pneumothorax group had a higher mean airway pressure(Paw)at birth(p=0.01),within 1 hour of birth(p=0.01),and at pneumothorax diagnosis(p=0.04).Using multiple logistic regression with cluster robust SEs,higher Paw(OR 2.2,95%Cl 1.08 to 3.72,p=0.03)and PEEP(OR 1.8,95%CI 1.15 to 3.14,p=0.007)were associated with an increased risk of developing *** was no difference in survival(p=0.09).Conclusions Development of a pneumothorax in CDH neonates is independently associated with higher Paw and higher PEEP.A pneumothorax increases the likelihood of treated with ECLS,even with smaller defect.
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