PT - JOURNAL ARTICLE AU - Cynthia J Gries AU - David J Pierson TI - Tracheal Rupture Resulting in Life-Threatening Subcutaneous Emphysema DP - 2007 Feb 01 TA - Respiratory Care PG - 191--195 VI - 52 IP - 2 4099 - http://rc.rcjournal.com/content/52/2/191.short 4100 - http://rc.rcjournal.com/content/52/2/191.full AB - We present a case of a patient with severe chronic obstructive pulmonary disease who developed dramatic mediastinal and subcutaneous emphysema, without pneumothorax, following a difficult intubation. Misdiagnosis of tracheal rupture as barotrauma from alveolar overdistention initially delayed intervention and caused persistence of subcutaneous emphysema. Despite efforts to minimize tidal volume and airway pressure, the large airway disruption and positive-pressure ventilation resulted in tension subcutaneous emphysema with near-fatal hemodynamic compromise, oliguria, and respiratory acidosis. Decompression with subcutaneous vents immediately reversed the life-threatening circulatory and respiratory compromise and stabilized the patient until surgical correction of the tracheal tear could be accomplished.