Browse > Article
http://dx.doi.org/10.3345/kjp.2008.51.11.1179

Study of the risk factors for pulmonary interstitial emphysema related to mechanical ventilator care  

Kim, Sang Yeob (Department of Pediatrics, Daegu Fatima Hospital)
Lee, Pil Sang (Department of Pediatrics, Daegu Fatima Hospital)
Lee, Sang Geel (Department of Pediatrics, Daegu Fatima Hospital)
Publication Information
Clinical and Experimental Pediatrics / v.51, no.11, 2008 , pp. 1179-1184 More about this Journal
Abstract
Purpose : Pulmonary interstitial emphysema (PIE) primarily occurs in preterm infants suffering from respiratory distress syndrome (RDS) and kept under mechanical ventilator care. Therefore, this study aimed to examine various risk factors for PIE, to identify conditions that can decrease the possibility of PIE development. Methods : PIE classification was conducted for 183 patients diagnosed to have RDS and receiving mechanical ventilator care with pulmonary surfactant between March 2000 and February 2007. The characteristics of each patient were analyzed through retrospective examination of their medical histories. Results : Among 183 patients, 17 had PIE; all factors, including birth weight, gestational age, RDS grade III or above, chorioamnionitis, and premature rupture of membranes, were statistically significant (P<0.05). The period of mechanical ventilator use was statistically significant, but the peak mean airway pressure and peak partial pressure of inspired oxygen were not. PIE mainly occurred on the right side or both sides rather than the left side and mostly developed within 72 h. The PIE group showed higher mortality rate than the control group, and the major cause of mortality was pneumothorax. Conclusion : Risk factors for PIE in infants suffering from RDS and kept under mechanical ventilator care include low gestational age, low birth weight, chorioamnionitis, and premature rupture of membranes. If any risk factors are noted, the infant must be observed closely for at least 72 h after birth.
Keywords
Pulmonary interstitial emphysema; Respiratory distress syndrome; Pneumothorax; Chorioamnionitis;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Gaylord M S, Thieme R E, Woodall D L, Quissel B J. Predicting mortality in low -birth-weight infants with pulmonary interstitial emphysema. Pediatrics 1985;76:219-24
2 Morisort C, Kacet N, Bouchez M C, Rouland V, Dubos JP, Gremillet C, et al. Risk factors for fatal pulm onary interstitial em physema in neonates. Eur J Pediatr 1990;149:493-5   DOI
3 Watterberg K L, Demers L M, Scott S M, Murphy S . Chorioam nionitis and early lung inflam mation in infants in whom bronchopulm onary dy splasia dev elops. Pediatrics 1996;97: 210-5
4 Bomsel F. Radiolog icstudy of hyaline mem brane disease: 110 cases. J Radiol Electrol Med Nucl 1970;51:259-68
5 Caldwell E J, Powell R D Jr, Mullooly JP. Interstitialem physema: a study of phy siologic factors involved inexperimental induction of the lesion. Am Rev Respir Dis 1970;102: 516-25
6 Cocker J, Langley F A. Postgraduate obstetrical and gynaecological pathology. Oxford:Pergamom Press, 1973
7 Wung JT. Mechanical ventilation of the new born. Respiratory care for the new born. 9th ed. Columbia: Presbyterian medical center, 1996;9-33
8 Power JC, Bengali Z H. Elastase inhibitors for treatment of emphysema: approaches to synthesis and biological evaluation. Am Rev Respir Dis 1986;134:1097-100   DOI
9 Merritt T A, Cochrane C G, Holcomb K, Bohl B, Hallman M, Strayer D, et al. Elastase and alpha 1-proteinase inhibitor activity in tracheal aspirates during respiratory distress syndrome. Role of inflam mation in the pathogenesis of bronchopulm onary dysplasia. J Clin Invest 1983;72:656-66   DOI   ScienceOn
10 Pitknen O M, Hallman M, Andersson S M. Correlation of free oxygen radical-induced lipid peroxidation with outcome in very low birth weig htinfants. J Pediatr 1990;116:760-4   DOI
11 Johnson K J, F antone JC 3rd, Kaplan J, W ard P A. In vivo damage of rat lungs by oxygen metabolites. J Clin Invest 1981;67:983-93   DOI
12 Lyon A. Chronic lung disease of prematurity. The role of intra-uterine infection. Eur J Pediatr 2000;159:798-802   DOI
13 Speer C P. New insights into the pathogenesis of pulmonary inflam mation in preterm infants. Biol Neonate 2001;79:205-9   DOI   ScienceOn
14 Fletcher B D, Outerbridge E W, D unbar JS. Pulmonary interstitial emphysema in the new born. J Can Assoc Radiol 1970;21:273-9
15 Yu V Y, Wong P Y, Bajuk B, Szymonowicz W. Pulmonary interstitialem physem a in infants less than 1000 g at birth. Aust Paediatr J 1986;22:189-92
16 Yoon S W, Lee C, Namgung R, Han D G, Kim M J. Risk factors for pulmonary interstitialem physema (PIE ) in mechanically ventilated neonates with hyalinemem brane disease. J Korean Pediatr Soc 1997;40:318-25
17 Cabana M D, Benson JE, Smith A E, Baggett H C, Northington F J. Delayed presentation of pulmonary interstitialem physema. Clin Pediatr 2000;39:299-302   DOI
18 Campbell R E . Intrapulmonary interstitial em physema: a com plication of hyaline m em brane disease. Am J Roentgenol Radium Ther Nucl Med 1970;110:449-56   DOI
19 Brooks JG, Bustamante S A, Koops B L, Hilton S, Cooper D, Wesenberg R L, et al. Selective bronchial intubation for the treatment of severe localized pulmonary interstitial em physemain new borninfants. J Pediatr 1977;91:648-52   DOI
20 Senior R M, Tegner H, Kuhn C, Ohlsson K, Starcher B C, Pierce JA. The induction of pulmonaryem physema with human leukocyte elastase. Am Rev Respir Dis 1977;116: 469-75   DOI
21 Keszler M, Donn S M, Bucciarelli R L, Alverson D C, Hart M, Lunyong V, et al. Multicenter controlled trial comparing high-frequency jetventilation and conventional mechanical ventilation in new borninfants with pulmonary interstitial em physema. J Pediatr 1991;119:85-93   DOI
22 Cohen R S, S mith D W, Stev enson D K, Moskow itz P S, Graham C B. Lateral decubitus position as therapy for persistent focal pulm onary interstitial em physema in neonates: a prelim inary report. J Pediatr 1984;104:441-3   DOI
23 Guenter C A, Coalson JJ, Jacques J. Emphysema associated with intrav ascular leukocyte sequestration. Com parison with papain-inducedem physema. Am Rev Respir Dis 1981;123: 79-84
24 Kirschner P A, Strauss L. Pulmonary interstitial emphysema in the new borninfant, precursors and sequelae. A clinical and pathologic study. Dis Chest 1964;46:417-26   DOI
25 HiFOS tudy Group. Randomized study of high-frequency oscillatory ventilation in infants with severe respiratory distress syndrome. J Pediatr 1993;122:609-19   DOI   ScienceOn
26 Fujimura M, Kitajima H, Nakayama M. Increased leukocyte elastase of the tracheal aspirate at birth and neonatal pulm onary em physema. Pediatrics 1993;92:564-9
27 Leviton A, Paneth N, Reuss M L, Susser M, Allred E N, Dammann O, et al. Maternal infection, fetal inflam matory response, and brain dam age in very low birth weight infants. Developmental Epidemiology Network Investigators. Pediatr Res 1999;46:566-75   DOI   ScienceOn
28 Speer C P, Pabst M J, Hedegaard H B, Rest R F, Johnston R B Jr. Enhanced release of oxygen metabolites by monocytederiv edmacrophages exposed to proteolytic enzymes: activity of neutrophil elastase and cathepsin G. J Immunol 1984; 133:2151-6
29 Plenat F, Vert P, Didier F, Andre M. Pulmonary interstitial em physema. Clin Perinatol 1978;5:351-75   DOI
30 Thibeault D W, Lachm an R S, Laul V R, Kwong M S. Pulm onary interstitialem physema, pneumom ediastinum, and pneumothorax. Occurrence in the new borninfant. Am J Dis Child 1973;126:611-4   DOI
31 Speer C P, Ruess D, Harms K, Herting E, Gefeller O. Neutrophil elastase and acute pulmonary damage in neonates with severe respiratory distress syndrome. Pediatrics 1993;91: 794-9
32 Merritt T A, Hallman M, Holcomb K, Strayer D, Bloom B, Revak S, et al. Human surfactant treatment of severe respiratory distress syndrome: pulmonary effluent indicators of lunginflam mation. J Pediatr 1986;108:741-8   DOI