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Advances in Neonatal Care : Official... Apr 2023Air leaks, especially pulmonary interstitial emphysema (PIE), are increasingly uncommon respiratory complications of the newborn. Despite PIE having a decreasing...
BACKGROUND
Air leaks, especially pulmonary interstitial emphysema (PIE), are increasingly uncommon respiratory complications of the newborn. Despite PIE having a decreasing incidence, it continues to have a high morbidity and mortality rate. This makes PIE one of the most severe respiratory complications to affect a newborn. Air leaks occur when there is overdistension of the terminal airways or alveoli, which results in air dissecting into extra-alveolar spaces. Recognizing the signs of air leaks is paramount to allow for appropriate diagnosis and treatment of the newborn to improve morbidity and mortality. Treatment modalities range from positioning the newborn in the decubitus position to surgical intervention.
PURPOSE
To summarize current evidence on the pathophysiology, risk factors, diagnosis, treatment, and management of PIE and pneumothorax.
DATA SOURCES
Two databases were systematically reviewed with key words later. Articles in English with date restrictions from 2016 to current were included.
STUDY SELECTION
Inclusion criteria of randomized controlled trials, case studies/reports, and review articles were utilized. Twenty articles, primarily case reports and studies, were reviewed.
DATA EXTRACTION
Guidelines for data abstraction were followed via independent extraction by a single observer.
RESULTS
Qualitative results were utilized to formulate current treatment of air leaks.
IMPLICATIONS FOR PRACTICE
This article provides guidance for frontline neonatal providers on current treatment and management of air leaks in the newborn population.
Topics: Humans; Infant, Newborn; Risk Factors; Mediastinal Emphysema; Pneumothorax
PubMed: 36719092
DOI: 10.1097/ANC.0000000000001040 -
The American Surgeon Apr 2023
Topics: Humans; Mediastinal Emphysema; Conservative Treatment; Esophageal Perforation; Tomography, X-Ray Computed
PubMed: 33316163
DOI: 10.1177/0003134820956926 -
ANZ Journal of Surgery Jan 2023
Topics: Humans; Mediastinal Emphysema; Tomography, X-Ray Computed
PubMed: 36660864
DOI: 10.1111/ans.18147 -
The American Journal of Emergency... Mar 2022Pneumomediastinum is a rare complication of substance use, likely due to a Valsalva maneuver after drug inhalation. There are no previously documented associations...
Pneumomediastinum is a rare complication of substance use, likely due to a Valsalva maneuver after drug inhalation. There are no previously documented associations between pneumomediastinum and opioid use. A 30-year-old man with a history of recent heroin and fentanyl inhalation presented to the emergency department in respiratory distress requiring intubation. His course was complicated by pneumomediastinum which subsequently developed tension physiology. He required emergent surgical decompression with a "blowhole incision" to his anterior chest. Although a rare complication of polysubstance use, pneumomediastinum can progress to tension physiology, requiring prompt diagnosis and management.
Topics: Administration, Inhalation; Adult; Dyspnea; Fentanyl; Heroin Dependence; Humans; Male; Mediastinal Emphysema; Valsalva Maneuver
PubMed: 34556391
DOI: 10.1016/j.ajem.2021.09.008 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Sep 2019Pneumomediastinum (PM) is the term which defines the presence of air in the mediastinum. PM has also been described as mediastinal emphysema. PM is divided into two... (Comparative Study)
Comparative Study
BACKGROUND
Pneumomediastinum (PM) is the term which defines the presence of air in the mediastinum. PM has also been described as mediastinal emphysema. PM is divided into two subgroups called as Spontaneous PM (SPM) and Secondary PM (ScPM).
METHODS
A retrospective comparative study of the PM diagnosed between February 2010 and July 2018 is presented. Forty patients were compared. Clinical data on patient history, physical characteristics, symptoms, findings of examinations, length of the hospital stay, treatments, clinical time course, recurrence and complications were investigated carefully. Patients with SPM, Traumatic PM (TPM) and Iatrogenic PM (IPM) were compared.
RESULTS
SPM was identified in 14 patients (35%). In ScPM group, TPM was identified in 16 patients (40%), and IPM was identified in 10 patients (25%). On the SPM group, the most frequently reported symptoms were chest pain, dyspnea, subcutaneous emphysema and cough. CT was performed to all patients to confirm the diagnosis and to assess the possible findings. All patients prescribed prophylactic antibiotics to prevent mediastinitis.
CONCLUSION
The present study aimed to evaluate the clinical differences and managements of PMs in trauma and non-trauma patients. The clinical spectrum of pneumomediastinum may vary from benign mediastinal emphysema to a fatal mediastinitis due to perforation of mediastinal structures. In most series, only the SPM was evaluated in many aspects, but there are fewer studies comparing the evaluation and management of traumatic and non-traumatic PMs. The patients with TPM who have limited trauma to the thorax and who do not have mediastinal organ injury in their imaging studies can be followed up and treated like SPM patients who do not have mediastinal organ injury, and both have good clinical course.
Topics: Chest Pain; Dyspnea; Humans; Length of Stay; Mediastinal Emphysema; Recurrence; Retrospective Studies
PubMed: 31475317
DOI: 10.14744/tjtes.2019.03161 -
Neonatal Network : NN 2014A pneumomediastinum is an air leak in which the free air is concentrated in the mediastinum. Although most neonatal pneumomediastinums do not require intervention,... (Review)
Review
A pneumomediastinum is an air leak in which the free air is concentrated in the mediastinum. Although most neonatal pneumomediastinums do not require intervention, complications such as subsequent air leaks can arise. Proper radiologic identification, as well as an understanding of the anatomy and pathophysiology associated with a pneumomediastinum, are necessary for an accurate understanding and diagnosis. This article will review the interpretation of radiologic findings in a neonate with a pneumomediastinum.
Topics: Education, Nursing, Continuing; Female; Humans; Infant, Newborn; Male; Mediastinal Emphysema; Treatment Outcome
PubMed: 25161136
DOI: 10.1891/0730-0832.33.5.275 -
Expert Review of Respiratory Medicine 2023Limited data is available on the incidence and outcomes of pneumothorax (PTX), pneumomediastinum (PNM), and subcutaneous emphysema (SCE) in COVID-19 patients. This study...
BACKGROUND
Limited data is available on the incidence and outcomes of pneumothorax (PTX), pneumomediastinum (PNM), and subcutaneous emphysema (SCE) in COVID-19 patients. This study aimed to investigate the characteristics of these complications in hospitalized COVID-19 patients.
RESEARCH DESIGN AND METHODS
A retrospective study was conducted, involving adult COVID-19 patients admitted to Mayo Clinic Florida from 03/2020-06/2022. Patients were divided into two groups based on the presence or absence of PTX/PNM/SCE.
RESULTS
1926 hospitalized patients with COVID-19 were included, of which 518 were admitted to the ICU. The incidence of PTX/PNM/SCE was 6.3%. Patients with these complications were more likely to be male, Asian, and unvaccinated. Conversely, they were less likely to have chronic obstructive pulmonary disease. Patients who developed PTX/PNM/SCE after 72 hours of admission were more likely to receive high-dose corticosteroids and for an extended duration. The affected group had an adjusted odds ratio for in-hospital mortality of 13.32 (95%CI, 8.19-21.59) and ICU admission of 9.14 (95%CI, 5.3-12.78) compared to the unaffected group.
CONCLUSION
Although the occurrence of PTX/PNM/SCE in hospitalized COVID-19 patients was rare, it was associated with worse outcomes. Corticosteroids may contribute to the pathogenesis of these complications; however, further studies are needed to investigate this relationship in more detail.
Topics: Adult; Humans; Male; Female; COVID-19; SARS-CoV-2; Mediastinal Emphysema; Pneumothorax; Incidence; Retrospective Studies; Subcutaneous Emphysema; Adrenal Cortex Hormones
PubMed: 37675598
DOI: 10.1080/17476348.2023.2254689 -
Ugeskrift For Laeger Oct 2021This is a case report of a 35-year-old women who had spontaneous pneumomediastinum (SPM) during the second stage of labour. Although this condition during labor is very...
This is a case report of a 35-year-old women who had spontaneous pneumomediastinum (SPM) during the second stage of labour. Although this condition during labor is very rare, it is described in the literature as Hamman's syndrome. The symptoms are dyspnoea, chest pain and subcutaneous emphysema which leads to much more severe differential diagnoses that should be eliminated quickly. There has not yet been found any dispositions to the condition. Duration of the second stage of labour is a theoretic factor of relevance, which naturally puts nulliparas at a higher risk.
Topics: Adult; Chest Pain; Dyspnea; Female; Humans; Labor, Obstetric; Mediastinal Emphysema; Pregnancy; Subcutaneous Emphysema
PubMed: 34704924
DOI: No ID Found -
Oral and Maxillofacial Surgery Sep 2023This case report presents an iatrogenic induced mediastinal emphysema after restorative treatment of the lower left second molar, aimed to highlight the potential...
This case report presents an iatrogenic induced mediastinal emphysema after restorative treatment of the lower left second molar, aimed to highlight the potential life-threatening consequences, and providing diagnostics and treatment concepts of complicated dental induced emphysema based on literature review. A 74-year-old female patient was admitted to the emergency department due to a fall on her shoulder. Additional finding was a significant swelling of the face and neck. In the computer tomography of the head, neck, and thorax, a humerus fracture and pronounced soft tissue emphysema from the infraorbital region to the mediastinum was detected. The patient reported that she had been treated by her dentist 4 days earlier. The treatment had to be discontinued after beginning of a pronounced swelling. Other reasons for the emphysema could be excluded out on an interdisciplinary teamwork. The patient was monitored as an inpatient for 5 days and received intravenous antibiotic therapy. This case report shows the rare complication of pronounced mediastinal emphysema after root canal treatment. Emphysema should always be a differential diagnosis of soft tissue swelling and, in case of doubt, a general medical presentation should be made.
Topics: Humans; Female; Aged; Mediastinal Emphysema; Face; Molar; Tooth Extraction; Subcutaneous Emphysema
PubMed: 35680758
DOI: 10.1007/s10006-022-01088-5 -
Pediatrics in Review Jan 2024
Topics: Humans; Mediastinal Emphysema; Pneumothorax; Subcutaneous Emphysema
PubMed: 38161156
DOI: 10.1542/pir.2022-005907