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Pneumomediastinum and pneumothorax during emergency tracheotomy under spontaneous ventilation: Macklin meets Müeller?

M de la Matta-Martín1, M J Galán1, J Gallego1

  • 1Unidad de gestión clínica Bloque quirúrgico, Hospital General, Hospital Universitario Virgen del Rocío de Sevilla, Spain.

Revista Espanola De Anestesiologia Y Reanimacion
|December 3, 2015
PubMed

Insights

Emergency tracheotomy can cause serious air leaks due to airway obstruction. Understanding these mechanisms helps clinicians diagnose and manage complications like pneumomediastinum and pneumothorax.

Area of Science:

  • Medical Complications
  • Surgical Procedures
  • Pulmonary Medicine

Background:

  • Emergency tracheotomy is associated with potentially serious complications.
  • Air leaks, including pneumomediastinum, subcutaneous emphysema, and pneumothorax, are a significant concern.

Purpose of the Study:

  • To review the pathogenesis of gas leakage during emergency tracheotomy.
  • To discuss the mechanisms causing air leaks in this context.
  • To present cases and elucidate the primary cause of these leaks.

Main Methods:

  • Review of pathogenesis of gas leakage in emergency tracheotomy.
  • Presentation of two clinical cases of air leaks.
  • Analysis of mechanisms involving pleural pressures and alveolar over-pressurization.

Main Results:

  • Two cases of pneumomediastinum, subcutaneous emphysema, and pneumothorax following emergency tracheotomy under spontaneous ventilation were presented.
  • These complications were successfully resolved by chest drainage.
  • The primary cause identified was a combination of extreme negative pleural pressures during inspiration and over-pressurized alveoli due to expiratory obstruction.

Conclusions:

  • The study elucidates the plausible primary cause of air leaks during emergency tracheotomy.
  • Understanding these mechanisms aids in the clinical suspicion and diagnosis of such complications.
  • Prompt diagnosis and management, such as chest drainage, are crucial for resolution.
Keywords:
Barotrauma pulmonarEmergency tracheotomyEnfisema subcutáneoNeumomediastinoNeumotóraxPneumomediastinumPneumothoraxPulmonary barotraumaSubcutaneous emphysemaTraqueotomía urgente

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