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.