Related Experiment Videos
Pulmonary barotrauma in mechanical ventilation. Patterns and risk factors
R B Gammon1, M S Shin, S E Buchalter
1Department of Medicine, University of Alabama, Birmingham.
Chest
|August 1, 1992
Summary
Mechanical ventilation can cause barotrauma, including mediastinal emphysema and pneumothorax. Patients with ARDS face the highest risk, with elevated ventilator settings correlating to increased barotrauma incidence.
Area of Science:
- Medicine
- Pulmonology
- Critical Care
Background:
- Mechanical ventilation is crucial for critically ill patients.
- Barotrauma, including mediastinal emphysema (ME) and pneumothorax (PTX), is a known complication.
- Identifying risk factors and patterns is essential for patient management.
Purpose of the Study:
- To analyze roentgenographic patterns of ME and PTX.
- To determine risk factors for barotrauma in mechanically ventilated patients.
- To assess the progression from ME to PTX.
Main Methods:
- Retrospective review of 139 intubated patients in a medical intensive care unit.
- Evaluation of roentgenograms for ME and PTX.
- Comparison of ventilator parameters between patients with and without barotrauma.
Main Results:
- Barotrauma occurred in 34 patients; ME was the initial manifestation in 24.
- Ten patients with initial ME developed PTX (42% positive predictive value).
- Adult respiratory distress syndrome (ARDS) patients had the highest risk; COPD and pneumonia patients had intermediate risk.
- Elevated peak inspiratory pressure, PEEP, respiratory rate, tidal volume, and minute ventilation were associated with barotrauma.
Conclusions:
- ME is a frequent initial sign of barotrauma.
- ARDS, COPD, and pneumonia increase barotrauma risk in mechanically ventilated patients.
- Specific ventilator parameters may indicate heightened barotrauma risk.