Pediatr Emerg Med J.  2023 Apr;10(2):68-71. 10.22470/pemj.2023.00668.

Bilateral tension pneumothoraces in a preterm low-birthweight newborn: tube thoracostomy using four 7-French latex catheters performed by an emergency physician

• Kim M
• Park CW
• Do YW
• Nho WY

• KMID: 2540911
• DOI: http://doi.org/10.22470/pemj.2023.00668

Abstract

Neonatal tension pneumothorax is life-threatening. A tension pneumothorax on the right side was detected on a newborn boy weighing 2,380 g, who was born at 35 weeks of gestation. Given the unavailability of an on-duty thoracic surgeon and appropriately sized chest tubes in the neonatal intensive care unit, an emergency physician performed closed thoracostomy using two 7-French latex catheters. Immediately after the re-expansion of the right lung, left tension pneumothorax was newly detected. Two more 7-French latex catheters were inserted, relieving the left lesion. We consider that the right pneumothorax occurred due to the mixture of spontaneous rupture of the subpleural blebs and barotrauma during the initial positive pressure ventilation, while the left lesion did due to the high-flow oscillatory ventilation. Despite the limited availability of devices in the present case, a favorable outcome was achieved by the use of alternative catheters, which were chosen by the emergency physician.

Keyword

Infant, Low Birth Weight; Latex; Pneumothorax; Resuscitation; Thoracostomy; Urinary Catheterization

Figure

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  Fig. 1. Large-volume tension pneumothorax on the right side. Note the total collapse of the right lung with the mediastinal shift. An endotracheal tube is inserted.

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  Fig. 2. Insertion of the first, 7-French latex catheter (“1”). Volume of the tension pneumothorax remains despite the insertion.

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  Fig. 3. Insertion of the second catheter (“2”). Note the expansion of the right lung, return of the mediastinal structures to the midline, and newly detected left pneumothorax.

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  Fig. 4. Insertion of the third and fourth catheters (“3” and “4”). Note the resolution of bilateral pneumothoraces.

Reference

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