Haemodynamic changes and mean airway pressure threshold in extremely preterm infants (22–24 weeks of gestation) with tension pneumothorax

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus Pub Date : 2025-05-01 DOI:10.1016/j.resplu.2025.100954

Tomonori Kurimoto, Takuya Tokuhisa, Asataro Yara, Masaya Kibe, Hiroshi Ohashi, Masakatsu Yamamoto, Tsuyoshi Yamamoto, Eiji Hirakawa

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Abstract

Background

Extremely preterm infants (22–24 weeks of gestation) are at high risk of tension pneumothorax, a life-threatening condition that causes haemodynamic instability. This study aimed to analyse the haemodynamic changes associated with tension pneumothorax and identify the mean airway pressure (MAP) threshold associated with its onset.

Methods

This retrospective descriptive study was conducted in a Level III Neonatal Intensive Care Unit (NICU) (2014–2024). Infants born between 22 + 0 to 24 + 6 weeks of gestation who developed tension pneumothorax within 72 h of birth were included. Haemodynamic parameters, including central venous pressure (CVP), mean arterial pressure (mBP), heart rate (HR), saturation of percutaneous oxygen (SpO₂), fraction of inspired oxygen (FiO₂), and MAP, were analysed at baseline, pneumothorax onset, and post-decompression. Statistical analyses included the Wilcoxon signed-rank test and generalised linear mixed model (GLMM).

Results

The CVP significantly increased at the onset of pneumothorax (p = 0.004) and decreased post-intervention (p = 0.004). The mBP and HR declined at onset (p = 0.0005) and partially recovered post-intervention. MAP was significantly higher at onset (p = 0.003), and GLMM analysis showed that an MAP increase of ≥1.3 cmH₂O was associated with pneumothorax risk.

Conclusions

A sudden increase in CVP may serve as an early indicator of tension pneumothorax. An MAP threshold of ≥12 cmH₂O was linked to higher pneumothorax risk, emphasising the need for cautious ventilatory management. Persistent haemodynamic instability after decompression highlights the need for close monitoring. Further studies are required to refine the neonatal care strategies.

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极度早产儿（22-24周妊娠）张力性气胸的血流动力学变化和平均气道压力阈值

极度早产儿（妊娠22-24周）极易发生张力性气胸，这是一种危及生命的疾病，可导致血流动力学不稳定。本研究旨在分析与紧张性气胸相关的血流动力学变化，并确定与其发病相关的平均气道压力（MAP）阈值。方法本回顾性描述性研究于2014-2024年在某III级新生儿重症监护病房（NICU）进行。出生在22 + 0至24 + 6周的婴儿在出生后72小时内出现紧张性气胸。血流动力学参数，包括中心静脉压（CVP）、平均动脉压（mBP）、心率（HR）、经皮氧饱和度（SpO2）、吸入氧分数（FiO2）和MAP，在基线、气胸发病和减压后进行分析。统计分析包括Wilcoxon符号秩检验和广义线性混合模型（GLMM）。结果CVP在气胸发病时显著升高（p = 0.004），干预后显著降低（p = 0.004）。mBP和HR在发病时下降（p = 0.0005），干预后部分恢复。MAP在发病时显著升高（p = 0.003）， GLMM分析显示MAP升高≥1.3 cmH2O与气胸风险相关。结论CVP突然升高可作为紧张性气胸的早期指标。MAP阈值≥12 cmH2O与较高的气胸风险相关，强调需要谨慎的通气管理。减压后持续的血流动力学不稳定突出了密切监测的必要性。需要进一步的研究来完善新生儿护理策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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