Pneumothorax secondary to perforation of sequential bronchi by suction catheters☆

Abstract 

The Savvage Rate of infants with respiratory distress syndrome has improved remarkably since ventilatory support reached a high degree of sophistication.¹ Despite technical refinements, approximately 25% of those infants who require assisted ventilation will experience a tension pneumothorax.^2–4 Air leaks are frequently unavoidable because of the high pressures and volumes necessary to ventilate the poorly compliant lungs of these infants. The major cause of pneumothorax is a consequence of peribronchial air (pulmonary interstitial emphysema) which dissects along the bronchi and eventually breaks into the pleural cavity.⁵ We now report another mechanism of pneumothorax in the neonate. Most infants on a respirator require an indwelling endotracheal tube; repeated suctioning is essential to maintain patency of these tubes. In small infants, the distance between the carina and the lung parenchyma is short. In the past year in our institution, we have recognized four separate instances, in three patients, of pneumothorax secondary to perforation of segmental bronchi by suction catheters. In this communication, we will describe this unexpected cause of pneumothorax and propose guidelines for safe endotracheal suctioning in small infants.

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