Thirteen premature infants receiving
mechanical ventilation for
respiratory distress syndrome developed
pneumopericardium. All had high peak inflation pressures (mean, 42 mm Hg; range, 26 to 60 mm Hg), and all were on
positive end-expiratory pressure (PEEP) ventilation (mean, 3.1 mm Hg; range, 2.1 to 5.7 mm Hg) at the time that
pneumopericardium occurred. Arterial blood
gases, indices of respiratory support, and hemodynamic data were reviewed before and after the onset of
pneumopericardium in all patients. There was a statistically significant increase in peak inflation pressure (PIP) over the 16 hours prior to onset of
pneumopericardium (p less than 0.05). There was, however, no significant relationship between onset of
pneumopericardium and other respiratory variables, including PEEP. In the majority of patients,
pneumopericardium was associated with cardiac air tamponade. Various forms of treatment for
pneumopericardium were attempted, including observation, needle aspiration, and insertion of pericardial tubes. Review of the
therapy indicates that insertion of a pericardial tube under direct vision is the safest and most effective means of treating
pneumopericardium in infants. These data also suggest that PIP is more important than PEEP in predisposing neonates with
respiratory distress syndrome to
pneumopericardium.