Pulmonary Air Leak Syndromes Pulmonary

Pulmonary Air Leak Syndromes

Pulmonary air leak (PAL) syndromes are extremely significant for newborns and babies. PAL is tied in very closely with chronic lung disease and other respiratory problems such as respiratory distress syndrome. The immaturity of the lungs is a significant factor but infants that need conventional ventilation to function because they are premature and their lungs are not yet ready to take in air properly can develop PAL. By using what is called high frequency oscillatory ventilation as opposed to conventional ventilation, it is thought that the pulmonary dysfunction in many preterm infants can be improved while not raising such a risk of PAL. Research into this issue indicates that there have been very few clinical trials or studies done regarding it. However, it does appear that the one study that was done showed a decrease in any new pulmonary air leaks when high frequency oscillatory ventilation was utilized. This is very important for babies that have pulmonary issues when they are born. However, the study also indicated that there was no significant mortality difference overall and that there was no difference in some specific types of PALs such as pneumomediastinum or pneumothorax. This would indicate that the amount of data available on high frequency oscillatory ventilation is not conclusive enough to determine whether it actually makes a difference in stopping PAL (www.nichd.nih.gov,2004).

The idea of high frequency oscillatory ventilation, however, is relatively new and is designed as a different way to provide artificial ventilation into the lungs. The theory indicates that less injury to the lungs may be produced, and this is especially true when rather high pressures are used. In trials that were conducted on this type of ventilation, babies developed hemorrhage around and in the cerebral ventricles and it was indicated that the harm that this did could likely outweigh any type of benefit that would be seen. However, studies have also shown that this type of ventilation might be helpful in managing pulmonary interstitial emphysema, which is a form of PAL. There are many infants that are at risk from mortality or morbidity from PAL and they are often identified based on how low their birthweight was and how severe their lung disease actually is (www.nichd.nih.gov,2004).

Treatment for PAL is not something that really can be discussed because these pulmonary air leak syndromes comprise several different types of issues. However, pulmonary air leaks are, naturally, leaks of air from the lungs, and these can be quite severe. In general, they can lead to chronic lung disease and other problems. When babies have a significant amount of respiratory distress, pulmonary air leaks are often associated with it. One of the reasons that this takes place is that there is not enough surfactant in the lungs and when this coating is missing air is able to escape more easily. In babies that are full-term this is generally not a problem but preterm babies often have not made enough surfactant and their lungs are not yet prepared to handle the intake and exhalation of air correctly. Utilizing different types of surfactant is one of the ways that PAL can be treated because the coating on the inside of the lungs will help stop air from escaping. There are different types of surfactants that can be used and whatever works best for that baby and is utilized generally by that particular doctor will be the best choice. There are several specific areas that air can leak from and this is why pulmonary air leak syndromes are listed as a plural. Air may be leaking from one place or from more than one place depending on the severity of lung problems and any other chronic abnormalities or issues that the infant might be facing. The benefits of surfactants should not be overlooked, however, as some of them can reduce the incident rate of pulmonary air leak in preterm infants by as much as 45%. This is extremely significant to infants and preterm babies that are struggling to breath properly, and extremely significant to their parents as well (pediatrics.aapublications.org, 1997).