Chest
Clinical Investigations in Critical CarePulmonary Barotrauma in Mechanical Ventilation: Patterns and Risk Factors
Section snippets
MATERIAL AND METHODS
The medical records and chest roentgenograms of all patients requiring ventilatory support in the Hohenburg Critical Care Unit at the University of Alabama at Birmingham, a general medical intensive care unit (ICU), over a ten-month period were reviewed retrospectively. Patients were excluded if barotrauma was present prior to hospital admission or if the duration of ventilatory support was less than 24 h. One hundred forty-eight patients were identified. In nine cases, roentgenograms were
Incidence and Risk Factors
Barotrauma occurred in 34 patients (24 percent): 29 patients (21 percent) developed ME, and 20 patients (14 percent) developed PTX. Both ME and PTX occurred in 15 patients. Table 1 shows a breakdown of barotrauma cases according to admitting diagnosis. The highest rate of occurrence was seen in the adult respiratory distress syndrome (ARDS) group, with an intermediate risk seen in patients with chronic obstructive pulmonary disease (COPD) and pneumonia. Together, these diseases accounted for 60
DISCUSSION
In their landmark article published in 1944, Macklin and Macklin9 used animal models to develop a mechanism for the development of extra-alveolar air, concluding that the initial site of disruption is the base of perivascular alveoli and that risk for such disruption is primarily related to the pressure gradient between the alveolus and the vascular sheath. Air in the vascular sheath, or pulmonary interstitial emphysema (PIE), should therefore develop prior to other forms of barotrauma, with
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Dr. Gammon is under fellowship training support of the American College of Chest Physicians (Marion Merrell Dow Award, 1991-92).
Manuscript received September 16; revision accepted March 9.