Pneumothorax and conventional ventilation in the neonatal period.
BACKGROUND
Pneumothorax (pnth) as a form of the air-leak syndrome cannot be fully prevented during conventional and nonconventional ventilation. Therefore, all efforts targeted at elucidation, prognosis and prevention or decrease of the air-leak syndrome are important and essential. The objectives of the present study were to study the dynamics of the panel of indices based on the ventilator parameters and blood-gas analysis in newborns and premature neonates with pneumothorax treated with conventional ventilation who subsequently developed pneumothorax, to compare the results in survived with those of nonsurvived, to compare the computer models in the patients enrolled in the present study with the results presented in our previous investigations and to determine their clinical and prognostic significance for early detection of impending pneumothorax, the choice of optimal ventilatory technique, as well as their place with regard to the early and later evolution in the condition of the newborn.


METHODS
A total of 22 newborns (10 survived and 12 nonsurvived, born in term and prematurely) who had been treated with conventional ventilation and subsequently developed pneumothorax were enrolled in the present study. The primary data (clinical and laboratory-blood-gas analysis, ventilatory parameters and their derivative indices--MAP, OI, VI, a/A, VEI, AaDO2), were calculated using the Neonatal Intensive Computer File.


CONCLUSIONS
We followed prospectively the dynamics of the panel of indices and compared the values and the major trends between the survived and the nonsurvived with pneumothorax as well as the computer models of the dynamics of the indices in the neonates with pneumothorax and the general pattern for the respective group as presented in our previous studies. Another important point in the comparative discussion is the significant difference in the values of R2.


CONCLUSIONS
1. The dynamics of the indices that we followed shows some characteristic findings and differences between the survived and nonsurvived newborns with pnth during the first three days following the initiation of conventional ventilation. 2. We found a significant difference in the values and dynamics of the indices between the newborns with pnth and those from the general groups. 3. Despite the fact that the predictive value of the panel of indices in newborns with pnth is lower as compared with the general groups, the interactions have important clinical implications for the management of artificial ventilation in high-risk newborns.
Despotova-Toleva
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D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D011030:Pneumothorax / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D015656:Respiratory Mechanics