Pulmonary air leaks

Pulmonary Air Leaks

Occurs in infants with underlying lung disease. It refers to a collection of gas outside the pulmonary compartment. Asymptomatic pneumothorax is more common than symptomatic pneumothorax.

Transpulmonary pressures that exceed the strength of the terminal airways and alveoli can damage the respiratory epithelium. The air enters the interstitium, causing pulmonary interstitial emphysema, then dissection of air toward the visceral pleura and/or the hilum through the peribronchial and perivascular spaces.

sudden desaturation after stabilized birth

Rupture of the Pleural Surface Allows the Air to Decompress:

Into the pleural space > Pneumothorax
Into the mediastinum > Pneumomediastinum
Into the pericardium > Pneumopericardium
Into the fascial and neck skin > Subcutaneous emphysema
Into the retroperitoneum and peritoneum > Pneumoperitoneum
Into the scrotum or labial folds > Pneumoscrotum
Into the pulmonary veins > Air embolism (Pneumocardium)

Risk Factors in Premature Infants

Respiratory distress syndrome (RDS)
Mechanical ventilation(Pneumothorax, displacement of tube, obstruction; mucous, equipment failure)
Meconium aspiration
Neonatal sepsis

Surfactant therapy for RDS has markedly decreased the incidence of pneumothorax.

Risk Factors in Term Infants

Aspiration of meconium, blood, or amniotic fluid
Pneumonia
Congenital lung malformations (congenital lobar emphysema)
Mechanical ventilation

Pneumothorax Treatment

In asymptomatic patients, a short course of oxygen is given (8-12 hours) to help absorb the air in the pleural cavity. Repeated chest X-ray is done to follow up improvement.

In symptomatic patients:

A 22-gauge angiocatheter is placed perpendicularly to the chest wall in the 2nd intercostal space in the midclavicular line or in the 5th intercostal space in the midaxillary line.

Tension right pneumothorax In Case of Large Pneumothorax

The mediastinum and heart may be pushed to the other side, absent of breath sounds on the ipsilateral side, shifting of cardiac impulse to the contralateral side.