SUBATMOSPHERIC OXYGEN-THERAPY COMPLICATING SUBCUTANEOUS EMPHYSEMA

An infant with hypoplastic left heart syndrome, excessive pulmonary bl ood flow, and tachypnea was placed on subatmospheric oxygen (supplemen tal nitrogen) to increase pulmonary vascular resistance and decrease p ulmonary blood flow. His cardiorespiratory status stabilized without m echanical ventilation, but 2 weeks later he developed spontaneous subc utaneous emphysema. The emphysema worsened over approximately 1 month. During this time his left-to-right shunt gradually decreased, and he was weaned to room air. Even without the use of supplemental oxygen th e emphysema resolved without complication, and the patient underwent s uccessful orthotopic heart transplantation at 65 days of age.