Spontaneous bilateral collapsed lungs

[idahostudent2011]

Hey, I have a question. There is a two month old, who was born at 33 weeks, went in for a bilateral inguinal hernia surgery. The surgery went well,(they were pretty big hernias that did need to be done) but after the surgery the infant went into resperatory distress. The doctors ordered an x-ray and the kid has bilateral collapsed lungs. He is in NICU, on a c-pap machine and he is doing better. I was wondering why this would happen during a pretty routine surgery. Before surgery he was doing pretty well, but after eating his O2 would drop to around 86-88% on room air. It would rise back to 100% in about 30 mins. I'm very interested on why this would happen. Thanks a lot!

[NotReady4PrimeTime, RN]

Collapsed as in pneumothorax, or collapsed as in severe atelectasis?

Pneumothorax in this type of patient could be related to high pressure ventilation (barotrauma) or over-inflation (volutrauma) of the lungs in the OR during the surgery. Lungs of premature infants are often not quite normal even once they reach 'term' and are easily injured. High pressure or large volumes can cause a leak in one or more alveoli which allows air to accumulate in the pleural space, which then displaces lung tissue preventing the alveoli in that part of the lung from inflating. Small pneumos will reabsorb as long as the air leak doesn't persist. Larger ones will need needle decompression or a chest tube.

Atelectasis on the other hand can be caused by under-inflation of the lungs in the OR, which is more typical. This is the collapse of the alveoli due to inadequate pressure, volume or both. In the OR the tendency is to under-ventilate; the anaesthetist cannot see the patient's chest wall movement and goes by the oximeter on the console. If the sats are good, all is well, right? And the baby is 'asleep' so s/he can't adjust work of breathing to compensate.

CPAP would be a reasonable treatment in both cases. Your description of the child's desats with feeds suggest that his lungs are still not quite mature. Most children's hospitals insist that infants who were born prematurely who undergo general anaesthetic for any reason in the first year be admitted to ICU or a monitored bed for 24 hours post-op for just this reason.

[idahostudent2011]

Thank you for your reply, Atelectasis sounds right....poor baby...this all is very interesting, and I can't wait to learn more about peds....that is first up in this semester...

[NotReady4PrimeTime, RN]

You're welcome. I hope you'll love peds as much as I do!