Pulmonary Interstitial Emphysema

*~RIZKA GIA NOVITA ~*

DEFINISI
Masuknya udara ke dalam pulmonary interstitium, lymphatic and venous circulation,
duktus alveolar pecah (biasanya di persimpangan bronchiole dan duktus alveolar)

FAKTOR RESIKO
Prematurity (< 32 weeks GA)
VLBW (< 1,000 g)
Low Apgar score (< 5 ) and need of resuscitation
Positive pressure ventilation
Use of ↑ ↑vT) Peak inspiratory pressure (PIP), Tidal volume ( vT ) & ↑
Inspiratory time (Ti)
RDS, Meconium aspiration syndrome, Amniotic fluid aspiration
Infection , Neonatal sepsis, Pneumonia
Pulmonary hypoplasia

KLASIFIKASI
Biasanya pada 72 jam pertama kehidupan
Acute ( less 7 days) or persistent
Localized or diffused
Unilateral or bilateral]

FREKUENSI
􀂄 Currently is uncommon because of post natal surfactant, gentle ventilation and high
frequency ventilation
PATOFISIOLOGI
􀂄 Mechanical ventilation with large tidal volume increases the number of neutrophils
and cytokines in the lungs and also the permeability of the capillary membrane, leading
to pulmonary edema
􀂄 Recent studies have demonstrated presence of free elastase and alpha 1- proteinase
inhibitor as well as elastase alpha 1 proteinase inhibitor in tracheal aspirate of neonates
with severe RDS
􀂄 PIE infants appear to have free elastase activity in tracheal aspirate fluid

DIAGNOSIS
􀂄 Mainly a radiographic and pathologic diagnosis
􀂄 Blood gas show PCO2 (meningkat) and PO2 (turun)
􀂄 Increased respiratory support demand
􀂄 Increased lung volumes
􀂄 AP CXray :
􀂄 linear, oval or spherical cystic air-containing spaces (1 mm to 1 cm)
􀂄 Pneumothorax
􀂄 Heart tends to get smaller
􀂄 intrathoracic pressure (meningkat) ...lung volume (meningkat)

DD
􀂄 Bronchopulmonary dysplasia (BPD) (lucency is less linear)
􀂄 Respiratory distress syndrome
􀂄 Congenital cystic adenomatoid malformation (CCAM)

KOMPLIKASI
􀂄 Loss of pulmonary compliance
􀂄 Epitheliazation of the interstitial air pockets
􀂄 Air embolus in pulmonary venous circulation
􀂄 Rupture of subpleural lymphatic blebs (pneumothorax)

*BPD
􀂄 Rupture of bronchial connections and release of air into the interstitium promotes
edema and oxidant injury
􀂄 Highest risk for VLBW infant, low GA and PIE in first 24 hrs of life. Increased risk for
IVH in pneumothorax.

TATALAKSANA
􀂄 Localized 􀂄 Conservative management 􀂄 Decubitus position with affected side down
􀂄 Selective intubation of the main bronchus on the uninvolved side (10 days) 􀂄
Lobectomy 􀂄 High frequency oscillatory ventilation (low volumes of gas and low
pressure)