1,116 results match your criteria Barotrauma and Mechanical Ventilation


Subcutaneous Emphysema and Pneumomediastinum Following Non-invasive Ventilation in a Patient With Severe COVID-19 Disease.

Cureus 2021 Jun 30;13(6):e16051. Epub 2021 Jun 30.

General Medicine, Gandhi Hospital, Hyderabad, IND.

Subcutaneous emphysema (SE) and pneumomediastinum are rare complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While SE is often non-fatal and usually self-remitting, pneumomediastinum can be fatal with high mortality rates depending on the underlying etiology. Here, we present the case of a 39-year-old otherwise healthy male who tested positive for SARS-CoV-2. Read More

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Intraoperative Ventilation in the High-Risk Surgical Patient.

Respir Care 2021 Aug;66(8):1337-1340

Department of Anesthesiology, University of California San Diego, San Diego, California.

Postoperative pulmonary complications contribute to perioperative morbidity and mortality in addition to being associated with increased health care costs. In this review article, we outline risk factors for the development postoperative pulmonary complications, describe their impact on perioperative outcomes, and focus on the role of intraoperative ventilation strategies in decreasing postoperative pulmonary complications. Read More

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Adverse Events of Prone Positioning in Mechanically Ventilated Adults with Acute Respiratory Distress Syndrome.

Respir Care 2021 Jul 23. Epub 2021 Jul 23.

Master program in Physical Therapy and Rehabilitation, Carrera de Kinesiología, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile.

Introduction: Prone positioning is a therapy utilized globally to improve gas exchange, minimize ventilator-induced lung injury, and reduce mortality in acute respiratory distress syndrome (ARDS), particularly during the ongoing coronavirus disease 2019 (COVID-19) pandemic. While the respiratory benefits of prone positioning in ARDS have been accepted, the concurrent complications could be undervalued. Therefore, this study aimed to identify the adverse events related to prone positioning in ARDS, and secondarily, to collect strategies and recommendations to mitigate these adverse events. Read More

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[Experimental study on liver injury induced by intraperitoneal hypertension under mechanical ventilation].

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2021 Jun;33(6):740-743

Department of Tumor Surgery, the Affiliated Hospital of Shanxi Datong University, Datong 037005, Shanxi, China. Corresponding author: Wang Hongye, Email:

Objective: To investigate the effects of mechanical ventilation on liver cytological and enzymatic indexes in abdominal compartment syndrome (ACS) by establishing a porcine model of abdominal hypertension.

Methods: Six healthy adult pigs were selected. After general anesthesia, they were intubated and given ventilator assisted breathing. Read More

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Treatment of the lung injury of drowning: a systematic review.

Crit Care 2021 07 19;25(1):253. Epub 2021 Jul 19.

College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia.

Background: Drowning is a cause of significant global mortality. The mechanism of injury involves inhalation of water, lung injury and hypoxia. This systematic review addressed the following question: In drowning patients with lung injury, what is the evidence from primary studies regarding treatment strategies and subsequent patient outcomes?

Methods: The search strategy utilised PRISMA guidelines. Read More

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Effect of different levels of PEEP on mortality in ICU patients without acute respiratory distress syndrome: systematic review and meta-analysis with trial sequential analysis.

J Crit Care 2021 Jul 3;65:246-258. Epub 2021 Jul 3.

Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China. Electronic address:

Objective: To determine whether higher positive end- expiratory pressure (PEEP) could provide a survival advantage for patients without acute respiratory distress syndrome (ARDS) compared with lower PEEP.

Methods: Eligible studies were identified through searches of Embase, Cochrane Library, Web of Science, Medline, and Wanfang database from inception up to 1 June 2021. Trial sequential analysis (TSA) was used in this meta-analysis. Read More

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Higher versus lower positive end-expiratory pressure in patients without acute respiratory distress syndrome: a meta-analysis of randomized controlled trials.

Crit Care 2021 07 15;25(1):247. Epub 2021 Jul 15.

Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy.

Background: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the association of higher positive end-expiratory pressure (PEEP), as opposed to lower PEEP, with hospital mortality in adult intensive care unit (ICU) patients undergoing invasive mechanical ventilation for reasons other than acute respiratory distress syndrome (ARDS).

Methods: We performed an electronic search of MEDLINE, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science from inception until June 16, 2021 with no language restrictions. In addition, a research-in-progress database and grey literature were searched. Read More

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Early individualized positive end-expiratory pressure guided by electrical impedance tomography in acute respiratory distress syndrome: a randomized controlled clinical trial.

Crit Care 2021 06 30;25(1):230. Epub 2021 Jun 30.

Department of Biomedical Engineering, Fourth Military Medical University, 169 Changle Xi Rd, Xi'an, China.

Background: Individualized positive end-expiratory pressure (PEEP) by electrical impedance tomography (EIT) has potential interest in the optimization of ventilation distribution in acute respiratory distress syndrome (ARDS). The aim of the study was to determine whether early individualized titration of PEEP with EIT improved outcomes in patients with ARDS.

Methods: A total of 117 ARDS patients receiving mechanical ventilation were randomly assigned to EIT group (n = 61, PEEP adjusted based on ventilation distribution) or control group (n = 56, low PEEP/FiO table). Read More

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Barotrauma during non-invasive ventilation for acute respiratory distress syndrome caused by COVID-19: a balance between risks and benefits.

Br J Hosp Med (Lond) 2021 Jun 30;82(6):1-9. Epub 2021 Jun 30.

Department of Emergency, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.

Ventilatory support is vital for the management of severe forms of COVID-19. Non-invasive ventilation is often used in patients who do not meet criteria for intubation or when invasive ventilation is not available, especially in a pandemic when resources are limited. Despite non-invasive ventilation providing effective respiratory support for some forms of acute respiratory failure, data about its effectiveness in patients with viral-related pneumonia are inconclusive. Read More

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Design and simulation of mechanical ventilators.

Chaos Solitons Fractals 2021 Sep 25;150:111169. Epub 2021 Jun 25.

University of Jeddah, College of Science, Department of Statistics, Jeddah, Saudi Arabia.

During this period of COVID-19 pandemic, the lack of medical equipment (like ventilators) leads to complications arising in the medical field. A low-cost ventilator seems to be an alternative substitute to fill the lacking. This paper presents a numerical analysis for predicting the delivered parameters of a low-cost mechanical ventilator. Read More

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September 2021

The effect of the volumetric flow rate and endotracheal tube diameter on the pressure distribution in human airways.

Med Eng Phys 2021 Jun 9;92:71-79. Epub 2021 May 9.

School of Chemical Engineering. University of Campinas. Campinas. São Paulo, Brazil. Electronic address:

The comprehension of the fluid flow in the upper airways is of paramount importance when treating patients under clinical conditions that demand mechanical ventilation. Barotrauma and overdistension are related to undesirable pressures and might be responsible for morbidity and mortality. In the current work we use computational fluid dynamics to investigate the pressure field in the upper respiratory airways. Read More

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Rapid-flow expulsion maneuver in subglottic secretion clearance to prevent ventilator-associated pneumonia: a randomized controlled study.

Ann Intensive Care 2021 Jun 24;11(1):98. Epub 2021 Jun 24.

Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.

Background: Following endotracheal intubation, clearing secretions above the endotracheal tube cuff decreases the incidence of ventilator-associated pneumonia (VAP); therefore, subglottic secretion drainage (SSD) is widely advocated. Our group developed a novel technique to remove the subglottic secretions, the rapid-flow expulsion maneuver (RFEM). The objective of this study was to explore the effectiveness and safety of RFEM compared with SSD. Read More

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High Peak Inspiratory Pressures After a Change of Heat and Moisture Exchangers: A Case Series.

A A Pract 2021 Jun 10;15(6):e01483. Epub 2021 Jun 10.

From the Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

Elevated peak inspiratory pressures (PIPs) cause harm via hypoventilation, barotrauma, and hemodynamic instability. Heat and moisture exchangers (HMEs) are used during mechanical ventilation to prevent heat loss, dehydration of airway mucosa, and accumulation of dried secretions. Multiple reports detail sudden HME occlusions causing increased PIPs. Read More

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Awake Extracorporeal Membrane Oxygenation in Coronavirus Disease 2019 Patients Without Invasive Mechanical Ventilation.

Crit Care Explor 2021 Jun 3;3(6):e0454. Epub 2021 Jun 3.

Department of Adult Intensive Care Unit, Fakeeh Care Group, Jeddah, Saudi Arabia.

Objectives/background: Extracorporeal membrane oxygenation is used as rescue therapy for patients with acute respiratory distress syndrome in whom conventional therapy has failed prior to an Extra Corporeal Membrane Oxygenator to rescue Lung Injury in Severe Acute Respiratory Distress Syndrome trial. Since then, extracorporeal membrane oxygenation has been incorporated as part of the standard treatment algorithm in many centers for patients with severe acute respiratory distress syndrome. Since the emergence of coronavirus disease 2019 in early 2020, extracorporeal membrane oxygenation has been used effectively as rescue therapy and as a bridge to recovery in some patients with refractory respiratory failure. Read More

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Serious complications in COVID-19 ARDS cases: pneumothorax, pneumomediastinum, subcutaneous emphysema and haemothorax.

Epidemiol Infect 2021 06 8;149:e137. Epub 2021 Jun 8.

Department of Anesthesia and Reanimation, University of Health Sciences Turkey, Sultan 2. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey.

The novel coronavirus identified as severe acute respiratory syndrome-coronavirus-2 causes acute respiratory distress syndrome (ARDS). Our aim in this study is to assess the incidence of life-threatening complications like pneumothorax, haemothorax, pneumomediastinum and subcutaneous emphysema, probable risk factors and effect on mortality in coronavirus disease-2019 (COVID-19) ARDS patients treated with mechanical ventilation (MV). Data from 96 adult patients admitted to the intensive care unit with COVID-19 ARDS diagnosis from 11 March to 31 July 2020 were retrospectively assessed. Read More

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The incidence, clinical characteristics, and outcomes of pneumothorax in hospitalized COVID-19 patients: A systematic review.

Heart Lung 2021 Sep-Oct;50(5):599-608. Epub 2021 May 1.

Department of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY, United States.

Background: Pneumothorax has been frequently described as a complication of COVID-19 infections.

Objective: In this systematic review, we describe the incidence, clinical characteristics, and outcomes of COVID-19-related pneumothorax.

Methods: Studies were identified through MEDLINE, Pubmed, and Google Scholar databases using keywords of "COVID-19," "SARS-CoV-2," "pneumothorax," "pneumomediastinum," and "barotrauma" from January 1st, 2020 to January 30th, 2021. Read More

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Covid-19 Pneumonia and Ventilation-induced Lung Injury: A Case Report.

Rom J Anaesth Intensive Care 2020 Dec 31;27(2):80-82. Epub 2020 Dec 31.

Intensive Care department, Maasstad Ziekenhuis, Rotterdam, The Netherlands.

We present the case of a 67-year-old male patient, who was admitted to the intensive care unit for hypoxemic respiratory failure due to severe COVID-19 pneumonitis, requiring mechanical ventilation. Despite close monitoring using transpulmonary pressure measurements and interventions to pursue lung-protective ventilation, the patient developed extensive barotrauma including a right-sided pneumothorax, subcutaneous emphysema and pneumomediastinum while on pressure support ventilation. We hypothesize that the high respiratory drive that COVID-19 patients seem to exhibit, combined with diffuse alveolar injury and increased alveolar pressure, resulted in gross barotrauma. Read More

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December 2020

Pneumothorax in critically ill patients with COVID-19 infection: Incidence, clinical characteristics and outcomes in a case control multicenter study.

Respir Med 2021 08 13;184:106464. Epub 2021 May 13.

Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, NY, USA.

Background: The clinical features and outcomes of mechanically ventilated patients with COVID-19 infection who develop a pneumothorax has not been rigorously described or compared to those who do not develop a pneumothorax.

Purpose: To determine the incidence, clinical characteristics, and outcomes of critically ill patients with COVID-19 infection who developed pneumothorax. In addition, we compared the clinical characteristics and outcomes of mechanically ventilated patients who developed a pneumothorax with those who did not develop a pneumothorax. Read More

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Barotrauma Linked to Coronavirus Disease 2019 Infection in Younger Patients: A Case Series.

Cureus 2021 Apr 20;13(4):e14573. Epub 2021 Apr 20.

Pulmonary Critical Care Medicine, Rutgers University, Newark, USA.

Patients infected with coronavirus disease 2019 (COVID-19) on invasive mechanical ventilation were found to have high rates of barotrauma. Herein, we present five patients admitted to the intensive care unit between March and April 2020, who developed barotrauma as a complication of COVID-19 pneumonia. This series includes four males and one female with a mean age of 54 years, most without significant chronic comorbidities or former tobacco use. Read More

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Minimally invasive surfactant therapy intubation for surfactant delivery in preterm infant with RDS: evaluation of safety and efficacy.

J Matern Fetal Neonatal Med 2021 May 23:1-5. Epub 2021 May 23.

Department of Neonatology, Ziv Medical Center, Tsfat, Israel.

Background: Minimally invasive surfactant therapy (MIST) is a promising mode of administration that offers the potential to limit barotrauma and prevent lung injury in preterm infants with respiratory distress syndrome (RDS).

Objective: This study assessed the effects of the implementation of MIST on safety and efficacy in infants who met criteria for surfactant administration and were treated by MIST as compared with a historical control group treated with surfactant an endotracheal tube during mechanical ventilation.

Methods: This retrospective study included infants born between 2012 and 2017 who met the following inclusion criteria: gestational age 23-36 + 6 weeks, a diagnosis of RDS requiring at least 30% oxygen with or without nasal continuous positive airway pressure (nCPAP). Read More

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Pulmonary Barotrauma in COVID-19 Patients With ARDS on Invasive and Non-Invasive Positive Pressure Ventilation.

J Intensive Care Med 2021 Sep 20;36(9):1013-1017. Epub 2021 May 20.

Pulmonary, Critical Care & Sleep Medicine, 12284University of Nebraska Medical Center, Omaha, NE, USA.

Background: We experienced a high incidence of pulmonary barotrauma among patients with coronavirus disease-2019 (COVID-19) associated acute respiratory distress syndrome (ARDS) at our institution. In current study, we sought to evaluate the incidence, clinical outcomes, and characteristics of barotrauma among COVID-19 patients receiving invasive and non-invasive positive pressure ventilation.

Methodology: This retrospective cohort study included adult patients diagnosed with COVID-19 pneumonia and requiring oxygen support or positive airway pressure for ARDS who presented to our tertiary-care center from March through November, 2020. Read More

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September 2021

Pneumothorax and pneumomediastinum in COVID-19 acute respiratory distress syndrome.

Monaldi Arch Chest Dis 2021 Apr 16;91(2). Epub 2021 Apr 16.

Department of Anesthesiology and Perioperative Medicine, Division of Critical Care, Mayo Clinic, Rochester, MN.

COVID-19 has involved numerous countries across the globe and the disease burden, susceptible age group; mortality rate has been variable depending on the demographical profile, economic status, and health care infrastructure. In the current clinical environment, COVID-19 is one of the most important clinical differential diagnoses in patients presenting with respiratory symptoms. The optimal mechanical ventilation strategy for these patients has been a constant topic of discussion and very importantly so, since a great majority of these patients require invasive mechanical ventilation and often for an extended period of time. Read More

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Physiologically variable ventilation and severe asthma. Comment on Br J Anaesth 2020; 125: 1107-16.

Authors:
W Alan C Mutch

Br J Anaesth 2021 06 24;126(6):e214. Epub 2021 Apr 24.

Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada. Electronic address:

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High-frequency oscillatory ventilation in children: A systematic review and meta-analysis.

Pediatr Pulmonol 2021 Jul 26;56(7):1872-1888. Epub 2021 Apr 26.

Pediatric Intensive Care Unit, Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.

Background: High-frequency oscillatory ventilation (HFOV) is an alternative mechanical ventilation mode proposed to reduce ventilator-induced lung injuries and improve clinical outcomes. The aim of this study was to determine the effects of HFOV compared to conventional mechanical ventilation (CMV) when used in children with hypoxemic respiratory failure.

Methods: The literature search was conducted to identify all studies published before December 2020. Read More

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Barotrauma in Patients with COVID-19 Infection on Invasive Mechanical Ventilation.

Turk Thorac J 2021 Mar 1;22(2):188-189. Epub 2021 Mar 1.

Department of Anaesthesiology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey.

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Decapneization as supportive therapy for the treatment of status asthmaticus: a case report.

J Med Case Rep 2021 Apr 8;15(1):200. Epub 2021 Apr 8.

Unit of Intensive Care, Department of Emergency, "A. Cardarelli" Hospital, Naples, Italy.

Background: Acute severe asthma is a life-threatening medical emergency. Characteristics of asthma include increased airway resistance and dynamic pulmonary hyperinflation that can manifest in dangerous levels of hypercapnia and acidosis, with significant mortality and morbidity. Severe respiratory distress can lead to endotracheal intubation followed by mechanical ventilation, which can cause increased air trapping with dynamic hyperinflation, predisposing the lungs to barotraumas. Read More

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Pneumomediastinum as a complication of COVID-19 disease: A case report.

Tuberk Toraks 2021 Mar;69(1):94-97

Department of Chest Diseases, İzmir Katip Çelebi University, İzmir, Turkey.

As the COVID-19 pandemic progresses, awareness of uncommon presentations of the disease increases. Such is the case with pneumomediastinum. Recent evidence has suggested that these can occur in the context of COVID19 pneumonia, even in the absence of mechanical ventilation-related barotrauma. Read More

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High versus low positive end-expiratory pressure (PEEP) levels for mechanically ventilated adult patients with acute lung injury and acute respiratory distress syndrome.

Cochrane Database Syst Rev 2021 03 30;3:CD009098. Epub 2021 Mar 30.

Argentine Cochrane Centre, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina.

Background: In patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), mortality remains high. These patients require mechanical ventilation, which has been associated with ventilator-induced lung injury. High levels of positive end-expiratory pressure (PEEP) could reduce this condition and improve patient survival. Read More

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Acute overventilation does not cause lung damage in moderately hemorrhaged swine.

J Appl Physiol (1985) 2021 05 18;130(5):1337-1344. Epub 2021 Mar 18.

Tactical and Enroute Care Research Department, United States Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas.

Airway management is important in trauma and critically ill patients. Prolonged mechanical ventilation results in overventilation-induced lung barotrauma, but few studies have examined the consequence of acute (1 h or less) overventilation. We hypothesized that acute hyperventilation, as might inadvertently be performed in prehospital settings, would elevate systemic inflammation and cause lung damage. Read More

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High Incidence of Barotrauma in Patients With Severe Coronavirus Disease 2019.

J Intensive Care Med 2021 Jun 15;36(6):646-654. Epub 2021 Mar 15.

Division of Pulmonary and Critical Care Medicine, 12222UCLA-Olive View Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

Objective.: To report the high incidence of barotrauma in critically ill patients admitted to the intensive care unit (ICU) with coronavirus disease 2019 (COVID-19) and to discuss its implications.

Design. Read More

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