Pulmonary Interstitial Emphysema

Pulmonary Interstitial Emphysema, better know in the NICU world as P.I.E.. What is PIE and why am I posting about it? First things first.

What is PIE?

Pulmonary interstitial emphysema (PIE) is a collection of gases outside of the normal air passages and inside the connective tissue of the peribronchovascular sheaths, interlobular septa, and visceral pleura secondary to alveolar and terminal bronchiolar rupture. Pulmonary interstitial emphysema is more frequent in premature infants who require mechanical ventilation for severe lung disease. Once pulmonary interstitial emphysema is diagnosed, intensive respiratory management is required to reduce mortality and morbidity.

Reference: http://emedicine.medscape.com/article/976801-overview, accessed on 2/22/11

Why am I posting about it?

My girls are struggling with PIE. Today Britian has developed PIE in both lobes of her lungs. Yesterday, Jillian had it in her right lung. Britian's has developed suddenly and has progressively gotten worse throughout today. Her Dr.'s are changing the settings on her high frequency jet vent, adding base to her fluids which should help with oxygen saturation, and waiting. We are all waiting, waiting and praying. Mortality and morbidity, those are two terms I can go without ever considering when thinking about my children. But alas, there it is, in black and white, PIE increases mortality and morbidity. Shoot an arrow straight through my heart, emotionally this is a tough one.

No one can tell me why she has developed PIE in both lungs so suddenly. Perhaps it is simply her severe prematurity or maybe the stress from this previous weekend has caught up with her. On Saturday Britian's breathing tube was changed because of an air leak. While changing the breathing tube Dr. Dagle tried her on the CPAP. Britian failed very quickly on the CPAP and the resulting lung issues have been a downward spiral. One of her lungs collapsed Saturday following the CPAP attempt, she was upgraded from the conventional ventilator to the high frequency jet vent, and is now battling PIE in both lobes. All steps in the WRONG direction.

There is a saying the NICU community; the first week is the "honeymoon" period. The girls and I are clearly out of the honeymoon. Physically they are struggling and fighting harder; emotionally I am falling and crashing harder. Before you go and post a comment on faith and hope or on how God is there for me. I know all of this, I truly do. But I am human, it is normal for me to struggle and fall to my knees in prayer.