Chest decompression in a ventilated neonate — OSCE

A 3-day-old premature infant (born at 28 weeks, now 1.2 kg) is intubated and ventilated for respiratory distress syndrome. The nurse calls you because the infant has suddenly desaturated to 70 per cent, the heart rate has fallen to 80, and the ventilator is alarming with a peak inspiratory pressure that has jumped from 18 to 34 cm of water. On examination the right hemithorax is expanded and moves less, is hyperresonant, and is silent on auscultation. You are the neonatal registrar asked to assess and manage the child.