Pneumomediastinum secondary to invasive and non-invasive mechanical ventilation
Pneumomediastinum (PM) is defined as the presence of abnormal gas in the mediastinum.
It is a known complication of invasive mechanical ventilation and has been reported with
non-invasive ventilation. Recent studies have reported that the incidence of barotrauma is
lowest in post-operative patients and is highest in mechanically ventilated patients with acute
respiratory distress syndrome. The incidence has dropped with the low tidal volume ventilation
technique. Chest x-rays can miss up to 25% of small PMs detected by computed tomography
scans of the chest. Pneumomediastinum is managed with low tidal volume ventilation with
plateau pressures <30 cm H2O and treatment of the underlying lung disease. Novel ways of
ventilation, such as high frequency oscillatory ventilation and asynchronous independent lung
ventilation, may improve ventilation in some patients.
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