Syndromes of air leakage from the lungs

Syndromes of air leakage from the lungs mean the spread of air outside its normal location in the airspace of the lungs.

Syndromes of air leakage from the lungs include pulmonary interstitial emphysema, pneumomediastinum, pneumothorax, pneumopericard, pneumoperitoneum and subcutaneous emphysema. These syndromes are found in 1-2% of healthy newborns, possibly due to the appearance of significant negative pressure in the chest cavity when the child begins to breathe, and accidental destruction of the alveolar epithelium, which allows air to escape from the alveoli into extra-alveolar soft tissues or spaces. Air leakage is most common and severe in children with lung damage who are at risk due to low elasticity of the lungs and the need for high airway pressure (with respiratory failure) or due to the formation of air traps (with meconium aspiration syndrome) , which leads to overgrowth of the alveoli. Many infants with this disorder have no clinical manifestations; the diagnosis is suspected clinically or in connection with the deterioration of 02status and is confirmed by chest radiography. Treatment varies depending on the type of leak, but in children, ventilation always includes reducing inspiratory pressure to a minimum tolerable level. High-frequency breathing apparatus can be effective, but do not have proven advantages.

Interstitial emphysema

Interstitial emphysema is a leak of air from the alveoli into the interstitial tissue and the lymphatic system of the lungs or the subpleural space. Usually, it occurs in children with low elasticity of the lungs, as, for example, with respiratory distress syndrome, which are located on the ventilator, but it can also occur spontaneously. One or both lungs can be affected, in each lung the lesion can be focal or diffuse. If the process is common, the respiratory status may deteriorate sharply, as lung elongation suddenly decreases.

Radiography of the chest shows a different number of cystic or linear enlightenments in the lungs. Some enlightenments are elongated; others look like subpleural cysts the size of a few millimeters to several centimeters in diameter.

Interstitial emphysema may disappear within 1-2 days or persist on the roentgenogram for weeks. In some patients with severe pulmonary disease and interstitial pulmonary emphysema, bronchopulmonary dysplasia develops, and cystic changes with prolonged interstitial lung emphysema then enter the X-ray picture of BPD.

Treatment, as a rule, is supportive. If one lung is involved much more than another, the child can be laid on the side of the more affected lung; this will facilitate the compression of the lung with interstitial emphysema, thereby reducing air leakage and possibly improving the ventilation of the normal (located above) lung. If one lung is severely affected, and the second lesion is mild or absent, you can try to separate intubation and ventilation of the less affected lung; soon the total atelectasis of the unventilated lung will develop. Since only one lung is now being ventilated, it may be necessary to change the parameters of the ventilator and the oxygen fraction in the inhaled mixture. After 24-48 hours, the intubation tube is returned to the trachea, at which time the air leakage may stop.

Pneumomediastinum

Pneumomediastinum is the penetration of air into the connective tissue of the mediastinum; air can then penetrate into the subcutaneous tissues of the neck and head. Pneumomediastinum usually has no clinical manifestations, although in the presence of subcutaneous air crepitation is noted. The diagnosis is made by radiography; in the anterior-posterior projection, air can form an enlightenment around the heart, while in the lateral projection the air lifts the thymus's shares from the shadow of the heart (a sign of the sail). Usually, treatment is not required, the improvement occurs spontaneously.

Pneumopericardium

Pneumopericardium is the penetration of air into the pericardial cavity. Virtually always marked only in children on ventilator. In most cases, it is asymptomatic, however, if enough air accumulates, it can lead to cardiac tamponade. The diagnosis is suspected if the patient develops an acute collapse and is confirmed by the detection of enlightenment around the heart on the radiograph or by obtaining air during pericardiocentesis using a needle to puncture the veins of the head. Treatment includes pericardial puncture followed by surgical insertion of the tube into the pericardial cavity.

Pneumoperitoneum

Pneumoperitoneum is the penetration of air into the abdominal cavity. It usually has no clinical significance, but a differential diagnosis should be made with pneumoperitoneum due to rupture of the hollow organ in the abdominal cavity, which is an acute surgical pathology.

Pneumothorax

Pneumothorax is the penetration of air into the pleural cavity; the accumulation of sufficient air can lead to intense pneumothorax. Usually clinically pneumothorax manifests tachypnea, dyspnea and cyanosis, although asymptomatic pneumothorax can also be noted. Breathing is weakened, the thorax increases from the affected side. Tense pneumothorax leads to the development of cardiovascular collapse.

The diagnosis is suspected due to a worsening of the respiratory status and / or chest radiography with a fiber optic probe. The diagnosis is confirmed by radiography of chest organs or in the case of intense pneumothorax - getting air during thoracocentesis.

In most cases, with a small amount of air in the pleural cavity, pneumothorax is resolved spontaneously, but with intense pneumothorax or a large volume of air in the pleural cavity it should be evacuated. With a strained pneumothorax, a needle for the puncture of the veins of the head or an angiocatheter and a syringe is temporarily used to evacuate the air. Radical treatment - the introduction of the French tube number 8 or number 10 for the chest, connected to a continuously working aspirator. Subsequent auscultation, X-ray and radiography confirm that the tube functions properly.