Presentation
Respiratory impairment after mechanical ventilation.
Patient Data
Computed tomography demonstrated bilateral pneumothorax, pneumomediastinum, extensive subcutaneous emphysema in cervical regions and anterior chest wall. There is also pneumoperitoneum. There is right pleural effusion and areas of higher density in the lung parenchyma corresponding to pneumonic foci. Endotracheal tube well located.
Case Discussion
In this case these appearances are typical of barotrauma. Barotrauma occurs between 4 and 15% of all patients undergoing mechanical ventilation.
Pulmonary barotrauma is the alveolar rupture due to the use of positive pressure. Clinical manifestations of barotrauma are multiple interstitial emphysema, pneumothorax, pneumomediastinum, subcutaneous emphysema, pneumoperitoneum, tension lung cysts and subpleural air cysts. As noted, all these forms of barotrauma are developed by a ruptured alveolus, overdistended with penetration of air into the perivascular interstitium or interstitial emphysema.
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