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Air leak (al) is a clinical phenomenon associated with the leakage or escape of air from a cavity that contains air into spaces that usually, under normal circumstances, do not have air They are often seen in infants being treated for respiratory distress syndrome (see chapter 34) The terminology air leak syndrome (als) is the presence of air leak with associated symptoms of respiratory distress.[1][2][3]

Air leak is more common and severe among neonates with lung disease, who are at risk because of poor lung compliance and the need for high airway pressures (eg, in respiratory distress) or because of air trapping (eg, meconium aspiration syndrome), which leads to alveolar overdistention Pulmonary air leak syndromes are common complications of mechanical ventilation in premature infants, especially when very high pressures are used Many affected neonates are asymptomatic.

Pathophysiology air leak begins with the rupture of an overdistended alveolus [1]

Overdistention may be due to generalized air trapping or uneven distribution of gas The air dissects along the perivascular connective tissue sheath toward the hilum, resulting in a pneumomediastinum, or into the pleural space, producing a pneumothorax [2]. The exact incidence of the air leak syndromes is difficult to determine The incidence increases in preterm infants to about 6%

Air leak syndrome (als) refers to the abnormal escape of air from the lungs into the chest cavity or surrounding tissues, often caused by lung injury or medical procedures. Air leak syndrome is a term used to describe problems that happen when air collects within a baby's chest, but outside the normal air cells of the lungs The air then creates pressure on the lungs and makes breathing very difficult. Air leak syndrome is the overarching diagnosis for one or more pathologic air collections present outside of the respiratory tract

Seven classic presentations in neonates include pulmonary interstitial emphysema (pie), pneumothorax, pneumomediastinum, pneumopericardium, pneumoperitoneum, subcutaneous emphysema, and systemic air embolism.

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