Barotrauma

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Barotrauma

  1. 1. BAROTRAUMA Debi McCutcheon, MIV Radiology Rotation March 26, 2007
  2. 2. Barotrauma-Definition  Injury to air-containing structures, such as the middle ears, sinuses, lungs, and gastrointestinal tract, due to unequal pressure differences across their walls .
  3. 3. Barotrauma-Etiologies  Mechanical Ventilation with or without acute respiratory distress syndrome  Surgery  Asthma  COPD  Interstitial lung disease  Pneumocystis carinii pneumonia
  4. 4. Barotrauma-Incidence  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.
  5. 5. Barotrauma-Pathophysiology  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 tidal volume.
  6. 6. Barotrauma-Pathophysiology  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.
  7. 7. Barotrauma-Complications  Pneumothorax  Interstitial emphysema  Pneumomediastinum-leads to PTX in 42% of patients in one study  Pneumopericardium  Subcutaneous emphysema  Pneumoperitoneum
  8. 8. Barotrauma-radiographic images  Early-pulmonary interstitial emphysema and subcutaneous emphysema
  9. 9. Barotrauma-Radiographic Images  Rt-mid lung-subpleural cyst
  10. 10. Barotrauma-Radiographic Images  One helluva Lft Pneumothorax
  11. 11. Barotrauma-Radiographic Images  Pneumomediastinum
  12. 12. Barotrauma-Radiographic Images  Pneumopericardium
  13. 13. Barotrauma-Radiographic Images  Pneumoperitoneum
  14. 14. Barotrauma-Treatments  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.
  15. 15. Bibliography  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.

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