Unsuccessful resuscitation of a preterm infant due to a pneumothorax and a masked tension pneumopericardium

Summary Pneumopericardium is the least common form of air leak in infants. A tension pneumopericardium is even more infrequent but associated with a very high mortality rate. We describe the case of an unsuccessful resuscitation in a preterm infant due to a pneumothorax and tension pneumopericardium...

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Bibliographic Details
Published in:Resuscitation 2008-08, Vol.78 (2), p.236-239
Main Authors: Cools, Bjorn, Plaskie, Katleen, Van de Vijver, Koen, Suys, Bert
Format: Article
Language:English
Subjects:
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Cardiopulmonary resuscitation (CPR)
Emergency
Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care
Fatal Outcome
Humans
Infant, Newborn
Intensive care medicine
Male
Medical sciences
Neonatal resuscitation
Pericardial tamponade
Pneumopericardium
Pneumopericardium - complications
Pneumopericardium - therapy
Pneumothorax
Pneumothorax - complications
Pneumothorax - therapy
Pulmonary Emphysema - etiology
Pulmonary Emphysema - therapy
Resuscitation - methods
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Summary:Summary Pneumopericardium is the least common form of air leak in infants. A tension pneumopericardium is even more infrequent but associated with a very high mortality rate. We describe the case of an unsuccessful resuscitation in a preterm infant due to a pneumothorax and tension pneumopericardium. Despite relatively mild pressure ventilation the patient developed massive pulmonary interstitial emphysema. The extra-alveolar air spread from the interstitium towards the mediastinal space (Macklin effect) and caused a pneumothorax and pneumopericardium, which evolved towards a tension pneumopericardium after a traumatic mechanical procedure. The infant deteriorated acutely. Despite prompt pleural drainage there were no signs of recovery at any time. Postmortal examination revealed a tension pneumopericardium and massive interstitial pulmonary emphysema, which was not obvious on radiographical investigation. In cases of acute deterioration of a ventilated neonate, one should always rule out pneumothorax. If the patient does not recover after pleural drainage and cardiac resuscitation a (tension) pneumopericardium should be considered.
ISSN:0300-9572
1873-1570
DOI:10.1016/j.resuscitation.2008.02.025