Pulmonary atelectasis in newborns with clinically treatable diseases who are on mechanical ventilation: clinical and radiological aspects.

OBJECTIVE: To analyze the radiological aspects of pulmonary atelectasis in newborns on mechanical ventilation and treated in an intensive care unit, associating the characteristics of atelectasis with the positioning of the head and endotracheal tube seen on the chest X-ray, as well as with the clinical variables. MATERIALS AND METHODS: This was a retrospective cross-sectional study of 60 newborns treated between 1985 and 2015. Data were collected from medical records and radiology reports. To identify associations between variables, we used Fisher's exact test. The level of significance was set at p < 0.05. RESULTS: The clinical characteristics associated with improper positioning of the endotracheal tube were prematurity and a birth weight of less than 1000 g. Among the newborns evaluated, the most common comorbidity was hyaline membrane disease. Atelectasis was seen most frequently in the right upper lobe, although cases of total atelectasis were more common in the left lung. Malpositioning of the head showed a trend toward an association with atelectasis in the left upper lobe. CONCLUSION: Pulmonary atelectasis is a common complication in newborns on mechanical ventilation. Radiological evaluation of the endotracheal tube placement provides relevant information for the early correction of this condition.

Pulmonary atelectasis in newborns with clinically treatable diseases who are on mechanical ventilation: clinical and radiological aspects / Atelectasia pulmonar em recém-nascidos com doenças clinicamente tratáveis submetidos a ventilação mecânica: aspectos clínicos e radiológicos

Abstract Objective: To analyze the radiological aspects of pulmonary atelectasis in newborns on mechanical ventilation and treated in an intensive care unit, associating the characteristics of atelectasis with the positioning of the head and endotracheal tube seen on the chest X-ray, as well as with the clinical variables. Materials and Methods: This was a retrospective cross-sectional study of 60 newborns treated between 1985 and 2015. Data were collected from medical records and radiology reports. To identify associations between variables, we used Fisher's exact test. The level of significance was set at p < 0.05. Results: The clinical characteristics associated with improper positioning of the endotracheal tube were prematurity and a birth weight of less than 1000 g. Among the newborns evaluated, the most common comorbidity was hyaline membrane disease. Atelectasis was seen most frequently in the right upper lobe, although cases of total atelectasis were more common in the left lung. Malpositioning of the head showed a trend toward an association with atelectasis in the left upper lobe. Conclusion: Pulmonary atelectasis is a common complication in newborns on mechanical ventilation. Radiological evaluation of the endotracheal tube placement provides relevant information for the early correction of this condition.

Resumo Objetivo: Analisar os aspectos radiológicos da atelectasia pulmonar em recém-nascidos com doenças clinicamente tratáveis submetidos a ventilação mecânica e atendidos em uma unidade de tratamento intensivo neonatal, associando características da atelectasia com o posicionamento da cabeça e da cânula endotraqueal na radiografia de tórax e com variáveis clínicas. Materiais e Métodos: Estudo de corte transversal e retrospectivo, em que foram incluídos 60 pacientes internados entre 1985 e 2015. A coleta dos dados foi realizada por meio da revisão dos prontuários e dos laudos das radiografias dos recém-nascidos. Para associação das variáveis foi realizado o teste exato de Fisher. O nível de significância adotado foi p < 0,05. Resultados: As características clínicas associadas à localização inadequada da cânula foram prematuridade e o peso ao nascer inferior a 1000 g. A doença clínica mais frequentemente encontrada foi a doença da membrana hialina. O lobo pulmonar superior direito foi o que apresentou maior frequência de atelectasia, e casos de atelectasia completa foram mais frequentes no pulmão esquerdo. O mau posicionamento da cabeça mostrou uma tendência de associação com atelectasia no lobo superior esquerdo. Conclusão: A atelectasia pulmonar representou uma complicação importante em recém-nascidos submetidos a ventilação mecânica, sendo a avaliação radiológica do posicionamento da cânula endotraqueal relevante para a correção precoce dessa condição.