A Case of Isolated Tension Pneumopericardium during Mechanical Ventilation in Extremely Low Birth Weight Prematurity

Abstract

Positive-pressure ventilation can cause various life-threatening barotraumas in cases of extremely low birth weight (ELBW) prematurity with lung disease. Isolated tension pneumopericardium unaccompanied by other barotraumas is very rare and can rapidly deteriorate. Sudden unexplainable hemodynamic collapse in premature infants receiving mechanical ventilation always requires urgent investigation. Here, we describe a case of isolated tension pneumopericardium in an ELBW premature male infant. The gestational age of 23 weeks, and the birth weight was 636 g. The infant was diagnosed with severe respiratory distress syndrome. After application of surfactant and conventional ventilation, oxygenation and vital signs improved briefly. However, the hypoxia worsened, requiring a higher pressure setting to maintain oxygenation and ventilation. When the oxygen saturation did not improve despite the higher pressure, we switched to a high-frequency oscillatory ventilator. At this point, the infant's condition suddenly deteriorated. We took a chest radiograph, started resuscitation, and quickly recognized a large amount of air compressing the heart. Vigorous resuscitation, including pericardial decompression, was actively performed but ultimately unsuccessful. We wish to bring this case to the attention of clinicians, who should always be aware of this fatal but treatable disease. Prompt recognition and intervention could be the only way to save the lives of affected infants.