BAROTRAUMA

Debi McCutcheon, MIV Radiology Rotation March 26, 2007

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 .

Barotrauma-Etiologies


    

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

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.

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.

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.

Barotrauma-Complications
  

  

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

Barotrauma-radiographic images

Early-pulmonary interstitial emphysema and subcutaneous emphysema

Barotrauma-Radiographic Images

Rt-mid lung-subpleural cyst

Barotrauma-Radiographic Images

One helluva Lft Pneumothorax

Barotrauma-Radiographic Images

Pneumomediastinum

Barotrauma-Radiographic Images

Pneumopericardium

Barotrauma-Radiographic Images

Pneumoperitoneum

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.

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.