Pulmonary hyperinflation. A form of barotrauma during mechanical ventilation

Barotrauma has been used to describe several specific complications related to mechanical ventilation. These include tension lung cyst, pneumothorax, pneumomediastinum, pneumoperitoneum, and subcutaneous emphysema. Pulmonary hyperinflation, another such complication, occurred in 6 patients, being fatal in 3. Two pathophysiologic mechanisms are discussed. The simpler, and well-recognized, ball-valve airway obstruction allows inspiration of air delivered by the mechanical ventilator but prevents expiration. A more complex circumstance exists when pulmonary contusion or infiltration produces differential lung compliances. This allows extreme hyperinflation of areas of normal lung during attempts to ventilate abnormal lung of low compliance. This mechanism is particularly evident when positive end-expiratory pressure (PEEP) is used in an attempt to open collapsed ventilatory units. Functional complications of lung hyperinflation include decreased alveolar ventilation and compression effects on adjacent structures. Interference with and shifts of regional lung perfusion may worsen gas exchange. Proper treatment includes airway clearance by bronchoscopy, the judicious use of bronchodilators, the discontinuance of PEEP, and adjustments of mechanical ventilators to prevent high airway pressures.