Subconjunctival emphysema as a complication of PEEP
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Subconjunctival emphysema occurred in a child receiving mechanical ventilation with high positive expiratory pressure (PEEP). This condition resolved when PEEP was reduced, highlighting PEEP
Area of Science:
- Pediatric Critical Care Medicine
- Ophthalmology
- Trauma Surgery
Background:
- Mechanical ventilatory support is crucial for critically ill patients.
- High positive expiratory pressure (PEEP) can lead to barotrauma.
- Subconjunctival emphysema is a rare complication of positive pressure ventilation.
Observation:
- A four-year-old girl developed subconjunctival emphysema after a motor vehicle accident.
- Air collection occurred in the conjunctiva, presenting as a ballooning.
- The emphysema was crepitant and reducible with gentle pressure.
Findings:
- The subconjunctival emphysema persisted during high PEEP ( > 18 cm H2O).
- The condition resolved completely after PEEP was decreased ( < 5 cm H2O).
- This case demonstrates a direct correlation between PEEP levels and subconjunctival emphysema.
Implications:
- Careful monitoring of PEEP is essential in pediatric patients.
- Subconjunctival emphysema may indicate underlying barotrauma.
- Management strategies should consider PEEP reduction for resolution.
Abstract:
This report describes the unusual case of a four-year-old girl who developed subconjunctival emphysema as a complication of mechanical ventilatory support with high positive expiratory pressure (PEEP)--which was applied after she sustained multiple injuries in a motor vehicle accident. The patient's left lower palpebral conjunctiva ballooned outward with air collection subconjunctivally, but it was crepitant and deflatable with light pressure. Saline, garamycin ointment, and Lacrilube were used to prevent drying. The condition persisted during the period when the patient required high PEEP (more than 18 cm H2O) but resolved after PEEP was decreased to below 5 cm H2O. The patient eventually died on the 66th ventilatory day due to complications of intractable tracheobronchial fistula and Pseudomonas pneumonia.