“…Coughing may be a precipitant factor of bullous rupture during MV or when the patient recovers consciousness. [ 2 ] Barlow et al ., investigated 100 patients undergoing tracheotomy and reported a 2% incidence of pneumothoraces, but did not advocate routine chest X-ray following this procedure. [ 6 ] Pneumothorax is often diagnosed in a patient with subcutaneous or mediastinal emphysema, oxygen desaturation, circulatory disturbance, or MV impairment with increase of peak pressure.…”