Teaching Case

Respiratory distress syndrome at birth. Pneumothorax at day 2.

At birth the weight was 1,1 kilos. She was reanimated by means of physical stimulation and oxygen mask. On the first day presented reduced oxygen blood saturation and chest x-ray demonstrated a respiratory distress syndrome. The second day she was intubated and chest x-Ray showed a left pneumothorax and a drainage was initiated. Pneumothorax completely resolved after two weeks.

Chest radiograms revealed in our case the onset of a pneumothorax in a preterm with distress respiratory syndrome that non uniformly involved the lung fields; the collapse of the left lung with the complete absence of the pulmonary plan were also observed. Pneumothorax corresponds to the extravasation of air in the pleural cavity and produces a partial or complete collapse of the adjacent lung. Pneumothorax is defined spontaneous when no traumatic or iatrogenic factors are involved. Respiratory distress syndrome or hyaline membrane disease are caused by surfactant deficiency and these are the conditions in which a pneumothorax occurs in spontaneously breathing so this is not primarily a complication of mechanical ventilation. Respiratory distress syndrome requiring ventilatory support is a common condition among small premature infants. Recently pneumothorax and other air leaks have been attributed to high ventilatory pressure (barotrauma) or volumes ( volutrauma). High ventilatory volumes induce pneumothorax in atelectasic lungs because inflated air is forced only into the expanded areas of the lung that result in volumetric overload. In the present case it is impossible to establish if the pneumothorax was spontaneous or iatrogenic.