BAROTRAUMA

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BAROTRAUMA

• Debi McCutcheon, MIV
• Radiology Rotation
• March 26, 2007

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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 .

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Barotrauma-Etiologies

• Mechanical Ventilation with or without acute
  respiratory distress syndrome
• Surgery
• Asthma
• COPD
• Interstitial lung disease
• Pneumocystis carinii pneumonia

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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.

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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.

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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.

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Barotrauma-Complications

• Pneumothorax
• Interstitial emphysema
• Pneumomediastinum-leads to PTX in 42 of patients
  in one study
• Pneumopericardium
• Subcutaneous emphysema
• Pneumoperitoneum

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Barotrauma-radiographic images

• Early-pulmonary interstitial emphysema and
  subcutaneous emphysema

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Barotrauma-Radiographic Images

• Rt-mid lung-subpleural cyst

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Barotrauma-Radiographic Images

• One helluva Lft Pneumothorax

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Barotrauma-Radiographic Images

• Pneumomediastinum

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Barotrauma-Radiographic Images

• Pneumopericardium

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Barotrauma-Radiographic Images

• Pneumoperitoneum

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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.

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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.