Pneumothorax and Barotrauma

First Things First (assess for & treat the following)

  • Recognize pressure-related injury. Alveolar rupture causes gas to dissect along the bronchovascular bundle, causing:
    • Pneumothorax/tension pneumothorax
    • Bronchopleural fistula
    • Lung & subpleural air cysts
    • Pulmonary interstitial emphysema
    • Pneumomediastinum
    • Pneumoperitoneum/pneumoretroperitoneum
    • Subcutaneous emphysema
    • Systemic gas embolism
  • Is urgent intervention needed?
    • Cardiac arrest (pulseless electrical activity)
    • Shock (BP < 80 mmHg; pulse >120)
    • Respiratory compromise (hypoxemia/hypercapnia)
      • Inability to ventilate; increased plateau (static pressure)
  • Radiographic abnormality only?
    • Careful monitoring required
    • Pneumomediastinum & subcutaneous emphysema have risk of pneumothorax.
    • Pneumothorax in mechanically ventilated patient requires a chest tube.

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Last updated: May 12, 2010