Debi McCutcheon, MIV
March 26, 2007
Injury to air-containing structures, such as
the middle ears, sinuses, lungs, and
gastrointestinal tract, due to unequal
pressure differences across their walls .
Mechanical Ventilation with or without acute
respiratory distress syndrome
Interstitial lung disease
Pneumocystis carinii pneumonia
Seen most frequently in ICUs. In a study
published in American Journal of
Respiratory Critical Care Medicine in April
2002, 13% of patients with acute lung injury
and/or acute respiratory distress syndrome
developed early barotrauma within four
days and was noted to be directly related to
increased levels of PEEP.
In mechanically ventilated patients,
ventilator induced lung injury (VILI) can
lead to barotrauma.
ARDS/ALI/Chronic Interstitial lung disease
have heterogeneous portions which
respond differently to pressure volume
introduced which leads to maldistribution of
Some alveoli become more distended than
others. Alveolar pressure increases and
forms a pressure gradient between the
alveoli and adjacent perivascular sheath.
Air dissects into the perivascular sheath
leading to perivascular interstitial
emphysema (PIE) and further moves into
areas of least resistance including
subcutaneous tissue and tissue planes.
Pneumomediastinum-leads to PTX in 42%
of patients in one study
Early-pulmonary interstitial emphysema and
Air must be evacuated with chest tube,
surgical evacuation, etc.
Lower tidal volumes are being used more
frequently to avoid this complication as
etiology appears to arise more from
increased volume as opposed to pressure.
http://www.emedicine.com. Barotrauma, July 10, 2006. Guy W Soo Hoo, MD,
Director, MICU, Associate Clinical Professor of Medicine, Pulmonary and Critical
Care Section, West Los Angeles VA Healthcare Center
Airway Pressures and Early Barotrauma in Patients with Acute Lung Injury and Adult
Respiratory Distress Syndrome, Mark D. Eisner. American Journal of Respiratory
Critical Care Medicine, Vol 165, No 7, April 2002, 978-982.
Dr. Neuffer, the coolest radiologist I ever knew.