What are Pneumothorax, Pneumomediastinum and
Pulmonary Interstitial Emphysema (PIE)?
Normally the air that we breathe goes down the
trachea (windpipe) to a series of branches of the windpipe called bronchi. The
air then goes to the air sacs where oxygen is delivered to the blood and carbon
dioxide is released. If the air sacs become overfilled with air, the air can
break out of the air sacs and get into spaces where it should not be. This
condition is sometimes referred to as AIR LEAK and includes the following:
-
PNEUMOTHORAX where the air is trapped inside
the chest between the chest wall and the lung, causing the lung to collapse.
-
PNEUMOMEDIASTINUM where air is trapped in the
middle part of the chest.
-
PULMONARY INTERSTITIAL EMPHYSEMA (PIE) where
air is trapped between the tiny air sacs, encircling the smallest blood
vessels and bronchi.
-
Less commonly, air can encircle the heart,
(Pneumopericardium),
get under the skin, (Subcutaneous Emphysema), leak into the abdomen (Pneumoperitoneum)
or surround the kidneys (Pneumoretroperitoneum). A baby often has more than
one form of air leak. For example, PIE can progress to pneumomediastinum
and/or pneumothorax.
Which babies get air leak?
Although air leak can happen in any baby, it is
more common if:
-
the baby has underlying lung disease, the more
severe the disease, the higher the risk for air leak.
-
the baby needs CPAP or mechanical ventilation
for treatment of lung disease
Why do preemies get air leak?
-
The lungs are not yet fully developed and the
air sacs are more susceptible to rupture.
-
If the baby has lung disease, some air sacs are
open and others are closed. Like blowing up balloons, it is easier to put
lots of air into an air sac that has been opened previously than it is to
put a small amount of air into an air sac that has never been opened.
-
There is more space between air sacs where
leaking air can collect as interstitial emphysema.
What can be done to treat air leak?
Some forms of air leak are more easily treated than
others. Approaches to treatment include:
-
If the air leak is small, not increasing, and
not causing significant problems, it may not need to be treated. The air
gradually reabsorbs into the body.
-
Occasionally a pneumothorax can be treated by
inserting a needle into the chest and sucking out the air with a syringe.
Often, however, the air will recollect.
-
If a tube can be placed in the area where air
is collecting, continuous suction on the tube can remove the air until the
leak seals over. This is the most common treatment.
-
In a pneumothorax a chest tube is placed
between two ribs and into the chest cavity between the lungs and the
chest wall.
-
In a pneumopericardium a tube is placed
between the heart and its covering, called a pericardial tube.
-
In interstitial emphysema and in
pneumomediastinum, the spaces containing the air are sponge-like and
cannot be treated with tubes.
-
If your baby has interstitial emphysema and is
on a ventilator (breathing machine), your baby's doctor may change to a
different pattern of ventilation (breathing). This may mean giving more
rapid, but smaller breaths or changing to a form of ventilation called high
frequency ventilation .
Is air leak serious?
Depending on the amount of air and the space where
it is located, the symptoms and seriousness of air leak may vary from mild to
catastrophic. A large pneumothorax or a pneumopericardium usually causes sudden
and rapid deterioration. Interstitial emphysema usually occurs more gradually.
When will it get better?
As your baby's underlying lung disease improves,
the air leak also improves. However, babies who have had air leak often improve
more slowly than babies who have not. When the tubes no longer drain air, they
will be removed. Once the tubes are out for more than a day AND the baby is off
the breathing machine or CPAP, airleak usually does not recur.
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