Pneumomediastinum secondary to invasive and non-invasive mechanical ventilation

Sara Mousa MD, Hawa Edriss MD

ABSTRACT

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.

Keywords: Pneumomediastinum, barotrauma, mechanical ventilation, air leak, ventilator induced lung injury

Article citation: Mousa S, Edriss H. Pneumomediastinum secondary to invasive and non-invasive mechanical ventilation. The Southwest Respiratory and Critical Care Chronicles 2019;7(27):36–42
From:The Department of Internal Medicine at Texas Tech University Health Sciences Center in Lubbock, Texas
Submitted: 5/1/2018
Accepted: 1/4/2019
Reviewer: Victor Test MD
Conflicts of interest: none
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