Ayus

重點在於足夠而且不會過多的的negative pressure!!

  我不喜歡遇到小小孩pneumothorax，但是對我來說，我可能是目前團隊裡面最不怕的那個了。
  畢竟以我之前倒楣的程度，你要叫我NI pigtail小公主我真是當之無愧。
  我不否認我有一點小小得意養了一個780g又recurrent pneumothorax的小小孩，但是我也永遠都記得那一陣子的有一個晚上，我跟學長姐站在她的床前心裡很清楚她就是tension 了我們卻怎樣tapping都沒有辦法release她的tension，差點CPR不回來的可怕經驗。
  不幸的，最近我又重溫了這個可怕的惡夢。而且，這一次我失去了這個小小孩。
 
  我去查了一些資料，放在這邊跟大家一起分享討論。

1. evacuation rate:
  -with single tube, capacity depends on level of water in chamber(cmH2O)
  -with multiple tubes, capcity depends on  applied vacuum.
2.Negative pressure of 20 cm H2O evacuates more than 4L of air/min
   in experimental setting
  -appropriate starting point for most infants with lung disease on ventilator is
   10 to 15 cm H2O
  -potentially inadequate in a case of bronchopleural fistula.
  -excessive suction pressure may draw tissues into the side holes of the 
   chest tube and could also be potentially harmful in changing
   intrapulmonary air flow in presence of smaller pleural leak
   (always start with 10 cm H2O)
＊measured rates across bronchopleural fistulas in infants have indicated ranges from 30 to 600 mL/min.If suction pressure is to high, gas flow to alveoli may be diverted across a fistula.The pressure and flow appplied tp the endptracheal tube also directly influence flow across a fistula.Because there are many interactive factors influcing how much air might have to be evacuated,there can be no single best suction level for all patients; the most effective , least harmful level has to e determined for each situation.

以下是我的一些想法：
1. 放小小孩的pigtail時，患側躺高60-75度，
   這樣可以讓入針的的地方會是air accumulation起來的地方。
2. 如果，你也沒有一個要六千多塊的pediatric underwater drainage system的話，
    chest bottle裡面的水柱高度起碼起碼要有十公分以上。
3.如果negatove pressure都到20公分水柱了引流效果還不好，
  重點是你的pigtail真的有funtion的話，那就加suction。
4.suction的pressure可以的話儘量keep在10以下。
5.有recurrent一直搞不定的recurrent pneumothorax時，
  可以考慮所謂的fibrin glue。
以上，over。