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Experience in the conservative and surgical treatment in children with sequels and emphysematous complications secondary to mechanical ventilation: series of cases and review of the literature

Sancho-Hernández, Rogelio; Cuevas-Schacht, Francisco Javier; Gutiérrez-Morales, Gabriel; Alva-Chaire, Adriana; Solorio-Rodríguez, Lizbeth





2019, Number 1

2019; 78 (1)






ABSTRACT

Introduction: Interstitial emphysematous disease (IED) is a group of conditions that affect ectopic air trapping in the pulmonary interstitium of the child in the context of an infectious process and secondary damage generated by mechanical ventilation; a functional-radiological-clinical classification that allows a diagnostic and therapeutic approach is proposed. Methods: A descriptive, retrospective and observational study in cases series with 13 patients with diagnoses confirmed by pathology IED and radiological and functional evaluation. They were divided into 3 groups: interstitial lobar emphysema acquired (ILEA), neonatal interstitial emphysema (NIE) and interstitial emphysema and barotrauma (IEB), congenital causes were excluded, infectious and mechanical ventilation factors, response to conservative and surgical approaches, mortality and complications were investigated. Results: In ILEA group: 3 persistent bronchiolitis obliterans diagnosed interstitial emphysema, pulmonary resection was performed with satisfactory outcome and other diagnostic biopsy with insidious evolution of their hypertensive vascular disease; NIE: 4, 3 lobectomy eradicated hypertension and pulmonary short circuit and progression broncodisplasia avoided, and another responded to conservative management with high frequency ventilation; IEB: 6 were treated with pleural drainage and represent the largest group lethality associated with pneumonia and a high ventilatory pressures. Conclusions: This classification allows a diagnostic and therapeutic orientation: ILEA and NIE group forecasts show improvement with lung resection if conservative options have failed; In the EIB group, conservative management and mild ventilatory strategies are recommended.

KEYWORDS

Pulmonary interstitial emphysema, barotrauma, lobar emphysema acquired, neonatal interstitial emphysema, air leak.

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2019, Number 1

2019; 78 (1)