PubMed · 8712342
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S Q Tighe. 1996. Transtracheal ventilation.. https://doi.org/10.1111/j.1365-2044.1996.tb13662.x
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OBJECTIVE: High pressures or volumes may increase the risk of barotrauma in the acute respiratory distress syndrome (ARDS). METHODS: The first part of the study analyzed data from a prospective trial of two ventilation strategies in 116 patients with ARDS retrospectively, and ventilatory pressures and volumes were compared in patients with or without pneumothorax. The second part consisted of a literature analysis of prospective trials (14 clinical studies, 2270 patients) describing incidence and risk factors for barotrauma in ARDS patients, and mean values of ventilatory parameters were plotted against incidence of barotrauma. RESULTS: In our clinical trial comparing two tidal volumes, 15 patients (12.3%) developed pneumothorax. There was no significant difference in any pressure or volume between these patients and the rest of the population, including end-inspiratory plateau pressure (P(plat)), driving pressure (P(plat)-PEEP), respiratory rate and compliance. Multiple trauma was more frequent among patients with pneumothorax (27%) than in those without (7%). Duration of mechanical ventilation tended to be longer with pneumothorax. In the literature review, the incidence of barotrauma varied between 0% and 49%, and correlated strongly with P(plat), with a high incidence above 35 cmH(2)O, and with compliance, with a high incidence below 30 ml/cmH(2)O. CONCLUSION: Clinical studies maintaining P(plat) lower than 35 cmH(2)O found no apparent relationship between ventilatory parameters and pneumothorax. Analysis of the literature suggests a correlation when patients receive mechanical ventilation with P(plat) levels exceeding 35 cmH(2)O.
A 24-week premature infant developed severe right-sided pulmonary barotrauma secondary to mechanical ventilation for respiratory distress syndrome (RDS). High-frequency oscillatory ventilation and permissive hypercapnia were initiated. A chest tube was placed to relieve a pneumothorax, and a catheter was inserted into an air-filled cyst for drainage. These maneuvers failed to improve the child's respiratory status. The child's left main-stem bronchus was then successfully fiberoptically intubated for single-lung ventilation in order to reduce the unilateral barotrauma. Single-lung ventilation was effectively and safely continued for 5 days, with complete resolution of the pulmonary barotrauma.
OBJECTIVES/HYPOTHESIS: Previous studies have shown a relationship between eustachian tube function and size of mastoid pneumatization, as well as eustachian tube function and middle ear (ME) barotrauma. The purpose of this study is to investigate a possible relationship between size of mastoid pneumatization and ME barotrauma in sports scuba (self-contained underwater breathing apparatus) divers. STUDY DESIGN: Prospective, blinded. MATERIAL AND METHODS: Twenty-four sports scuba divers (48 ears), who were fit to dive in the predive and otolaryngologic examination, were included in the study. Size of mastoid pneumatization was measured by simplified rectangular dimension method on a mastoid x-ray taken at Schüller's view. Divers were counseled to refer to the investigators if any symptoms occurred during and/or after diving. All symptomatic ears were examined within 24 hours of diving by the same investigator, who was blinded to the degree of pneumatization. RESULTS: ME barotrauma occurred in 15 ears (31%) of 11 divers (46%) at one time or another. The median degree of pneumatization in ears with barotrauma (22.9 cm2) was significantly smaller than that in unaffected ears (34.1 cm2; (P <.001). Furthermore, findings showed that with increasing degree of pneumatization, there was a decreasing risk of symptomatic barotrauma (P <.001). No barotrauma occurred in ears with a pneumatization greater than 34.7 cm2. However, barotrauma occurred in all 3 ears with a pneumatization degree smaller than 13.6 cm2. CONCLUSION: Our findings indicate an inverse relationship between size of pneumatization and risk of symptomatic ME barotrauma in sport scuba divers.