As pulmonary air leak syndrome is defined as the distribution of air outside the normal pulmonary airspace.
among the air-leak syndromes
As pulmonary air leak syndrome is defined as the distribution of air outside the normal pulmonary airspace. To the air leak syndromes (rare) include Pulmonary interstitial emphysema pneumothorax pneumomediastinum Pneumoperikardium pneumoperitoneum or subcutaneous emphysema pneumothorax and pneumomediastinum occur in approximately 1-2% of normal newborns before. Due to the large negative intrathoracic pressure that occurs when the newborn is breathing for the first time, a socket can rupture. This allows air to travel from the socket in extraalveolare places and tissues. Frequent and severe pronounced the Air leak syndrome in newborns with pulmonary disease due to poor lung compliance and because of the need for high ventilation pressures (eg. As respiratory distress syndrome) are at risk or because air is trapped (z. B. meconium aspiration syndrome [ meconium aspiration syndrome]), which leads to hyperinflation. Many affected newborns are asymptomatic. The diagnosis is suspected clinically or because the O2 saturation deteriorates and confirmed by X-ray. Treatment depends on the type of air leaks. In mechanically ventilated children inspiratory ventilation pressure is always reduced to the lowest values ??that are tolerated. High-frequency ventilators could be helpful to their advantage but is not yet proven. Pulmonary interstitial emphysema as pulmonary interstitial emphysema refers to the air passage of a socket in the pulmonary interstitium, lymph or subpleural space. It usually occurs in children who have a decreased lung compliance and (Idiopathic respiratory distress syndrome in newborns) must be mechanically ventilated for respiratory distress syndrome, but also occurs spontaneously. It is found either focal or generalized simultaneously in one lung or both lungs. In diffuse air crossing the respiratory situation can deteriorate quite suddenly due to decreased lung compliance. The chest X-ray shows a variable number of cystic or linear cloudy in the lungs. Partly cloudy are elongated, others appear to be widened, subpleural cysts and can be in diameter a few millimeters to a few centimeters. The pulmonary interstitial emphysema can decay rapidly within 1-2 days or radiologically persist for weeks. Some patients with severe pulmonary disease and pulmonary interstitial emphysema can bronchopulmonary dysplasia (BPD – bronchopulmonary dysplasia (BPD)) develop. The cystic changes of a long-standing pulmonary interstitial emphysema then transform each other for radiological image of a BPD. Treatment is mainly supportive. In mechanically ventilated infants lowering the tidal volume and airway pressure by the change can TRY to a high frequency ventilator or high frequency jet ventilator. This helps to compress the lung with interstitial emphysema. If a lung side is significantly stronger than the other, the child should be placed on the more affected side. In this way, the air leakage can be reduced and the ventilation of the other normal lung upper side can be improved. If a lung side and the other is very strong mild not affected by even a selective Bronchusintubation and ventilation can be attempted. A complete atelectasis of non-intubated lung takes place very soon. Since only one half of the lung can be ventilated, the ventilation parameters of the inspired O2 need to be harmonized. If hints of improvement of the air leaks exist, the endotracheal tube is pulled back into the trachea h at 24-48. A pneumomediastinum pneumomediastinum is an air transfer into the loose soft tissue of the mediastinum (pneumomediastinum); the air can penetrate further into the subcutaneous tissue of the neck and head. Although the pneumomediastinum usually causes no symptoms or findings that subcutaneous air causes a Crepitatio. The diagnosis is made by chest x-ray. In the antero-posterior beam path, the air forms a sickle light to the heart, while the lateral image of the air Thymuslappen the heart silhouette lifts (spinnaker sail characters). Treatment is usually not necessary, and the findings will disappear spontaneously. Pneumoperikardium If Pneumoperikardium it comes to air transfer into the pericardium. It affects almost exclusively mechanically ventilated infants. Most cases are asymptomatic, but if enough air accumulates, it can cause cardiac tamponade (pathophysiology). The diagnosis is suspected when infants have acute circulatory collapse, and is confirmed when around on the X-ray brightening around the heart to see or air is aspirated at a Perikardpunktion by a angiocatheter and syringe. is treated with a Perikardpunktion, followed by the installation of a pericardial. A pneumoperitoneum pneumoperitoneum refers to the passage of air into the abdomen. It is clinically insignificant, but must caused by a perforation of a loop of intestine, and illustrating a surgical emergency be distinguished from a pneumoperitoneum. The diagnosis is made on physical examination. Clinical symptoms with hard abdominal wall, lack of bowel sounds and signs of sepsis suggest a bowel perforation. Pneumothorax A pneumothorax is an air transfer into the pleural space. A sufficiently large accumulation of air can cause a tension pneumothorax (pneumothorax). Although he is sometimes asymptomatic, pneumothorax typically causes deterioration of tachypnea, moaning and cyanosis. The breath sounds are attenuated, and the chest expands on the affected side. A tension pneumothorax can lead to circulatory collapse. The diagnosis is suspected in a deterioration of the breathability in the transillumination of the thorax with a fiber optic light source, or both. The diagnosis is confirmed by X-ray or, in the case of a tension pneumothorax, by the escape of air at the plant of a chest tube. Most small pneumothorax reabsorb spontaneously, the larger and tension pneumothorax require the removal of air from the pleural space. In a tension pneumothorax a small (thickness 23 or 25) or a needle and a syringe angiocath can be used (thickness 18 or 20) to remove the free air from the pleural space. The final treatment consists in the installation to an 8-10 French chest tube with continuous suction. the correct position of the chest tube is then confirmed by auscultation, x-ray and transillumination.