Q: Pneumothorices and white rabbits?
11 Oct, 09 | by Bob Phillips
Not just Alice in Wonderland, it seems, but a bunch of our colleagues are chasing fluffy-tailed bunnies in their treatment of pneumothorax. Oxygen - in high concentrations - is used by some people to treat spontaneous, non-tension, pneumothorax. But why?
David Roberts, Paediatrician in Birmingham, UK, was set on the scent of this after an attendee at their emergency room was given oxygen overnight for a small pneumothorax and despite no obvious respiratory distress. Is there evidence for it, or is it (as with many things) just something we do because we think it should work?
Acknowledgement: Photo by leafar.
Dr Bob Philips :
I was in delivery room waiting for a newborn , son of a pre- eclamptic mother with about 33th weeks , gestational age . When she was born ( 1850 gms) , with good apgar , she required free-flow oxygen by about 1 minute with good adaptation . She didn´t required PPV .
She was put in oxyhood with fiO2 = 0.4.I ordered a chest Rx. I found an Pneumothorax near of 20% in the right side ( First hour ). Her saturation was 95 % .
I didn´t increase oxygen . Her silverman was 3 . Saturation of the newborn was always > 90 %. She had not increase work of breathing . In the next Rx ( three hours later ) there was not Pneumo.
I think that if the patient´s saturation is good ,she/he doesn´t need more O2 . I don´t want that my newborn has a saturation of more than 95 % ,in other ways i decrease oxygen concentration . With Fio2 0.4 we can get Po2> 150-200 mm Hg in normal lung .
The nitrogen in the pneumo washes out,interchange with O2 . But i think that there isn´t more interchange if the O2 is 200 or 300 mm Hg that if it´s 100 mm Hg or less .
In patients with large pneumothoraces with significant repiratory distress and blood gases changes , needle aspiration should be considered prior to chest tube insertion .
Alexis Palencia
Neonatologist , Colombia , South America
alexis palencia
November 2nd, 2009 at 3:56 pm