How is pulmonary interstitial emphysema (PIE) treated?

Updated: Jun 25, 2019
  • Author: Abhay J Bhatt, MD, MBBS; Chief Editor: Muhammad Aslam, MD  more...
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Answer

Admission/transfer to a neonatal intensive care unit (NICU) is indicated for infants with pulmonary interstitial emphysema (PIE). A thoracentesis set should be readily available due to the possibility of air leak, including pneumothorax and pneumopericardium.

Different treatment modalities have been used to manage PIE, with variable success.

Although the primary risk factor for PIE, prematurity, is rarely preventable, attention should be given to the use of as little mechanical ventilatory support as is necessary for the infant's very fragile lungs. An often-used strategy is to reduce the inspiratory time and/or decrease pressure along with adjusting the positive-end expiratory pressure (PEEP) enough to stent the airway will allow better emptying of the alveoli during expiration. [1] Close clinical observation by monitoring oxygen need, work of breathing and perfusion status, as well as judicious analysis of blood gas and chest x-ray, are essential to determine an optimal PEEP for a particular infant.

Because pneumothorax is a known complication of PIE, anticipatory guidance for this possibility should be provided for all those caring for the infant. Appropriate personnel should be readily available to address this complication.

In addition to pulmonary treatment, the overall importance of appropriate nutritional management of these ill newborns cannot be overstressed. Most of these infants are treated with total parenteral nutrition, and their nutritional needs require diligent attention.


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