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Two Cases of Pneumatoceles in Mechanically Ventilated Infants
Pulmonary pneumatocele is a thin-walled, gas-filled space within the lung that usually occurs in association with bacterial pneumonia and is usually transient. The majority of pneumatoceles resolve spontaneously without active intervention, but in some cases they might lead to pneumothorax with subs...
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Published in: | Oman medical journal 2015-07, Vol.30 (4), p.299-302 |
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Main Authors: | , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that cite this one |
Online Access: | Get full text |
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Summary: | Pulmonary pneumatocele is a thin-walled, gas-filled space within the lung that usually
occurs in association with bacterial pneumonia and is usually transient. The majority of
pneumatoceles resolve spontaneously without active intervention, but in some cases they
might lead to pneumothorax with subsequent hemodynamic instability. We report two
cases presented to the pediatric intensive care unit at the Royal Hospital, Oman with
pneumatoceles. The first was a 14-day-old baby who underwent surgical repair of total
anomalous pulmonary venous connection (TAPVC) requiring extracorporeal membrane
oxygenation (ECMO) support following surgery. He was initially on conventional
mechanical ventilation. Seven days after the surgery, he started to develop bilateral
pneumatoceles. The pneumatoceles were not regressing and they did not respond to three
weeks of conservative management with high-frequency oscillation ventilation (HFOV).
He failed four attempts of weaning from HFOV to conventional ventilation. Each time
he was developing tachypnea and carbon dioxide retention. Percutaneous intercostal chest
drain (ICD) insertion was needed to evacuate one large pneumatocele. Subsequently, he
improved and we were able to wean and extubate him. The second case was a two-monthold
male admitted with severe respiratory distress secondary to respiratory syncytial
virus (RSV) pneumonitis. After intubation, he required a high conventional ventilation
setting and within 24 hours he was on HFOV. Conservative management with HFOV
was sufficient to treat the pneumatoceles and no further intervention was needed. Our
cases demonstrate two different approaches in the management of pneumatoceles in
mechanically ventilated children. Each approach was case dependent and could not be
used interchangeably. |
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ISSN: | 1999-768X 2070-5204 |
DOI: | 10.5001/omj.2015.59 |