Pulmonary Barotrauma in the Intensive Care Unit

Abstract

Disruption of lung parenchyma by airway gas (baro trauma) frequently occurs in the intensive care unit. Gas may move from the airspace into several abnormal loca tions as a result of dissection along anatomical fascial planes to potentially produce interstitial emphysema, subpleural cysts, pneumomediastinum, subcutaneous emphysema, pneumopericardium, pneumothorax, pneu moperitoneum, pneumoretroperitoneum, bronchopleu ral fistulas, and air-entry into blood vessels. Although usually of limited clinical consequence, this extra-alve olar air may produce clinically significant morbidity and mortality. Recognition of these potential complications of pulmonary disease and its therapy may assist the clini cian in correctly diagnosing, avoiding, and treating the manifestations of pulmonary barotrauma.

Recommendations for Mechanical Ventilation during Donor Care

“…Although most of these manifestations of barotrauma do not harm the donor, tension pneumothorax, tension pneumomediastinum, tension pneumopericardium, and tension lung cysts have been reported and may cause impairment in cardiovascular function and/or gas exchange in the lung. 6 Increased airway pressure causes an elevation in total intrathoracic pressure which may reduce cardiac output. This reduction usually happens because venous blood return to the heart is reduced by the increased thoracic pressure.…”