RT Journal Article
SR Electronic
T1 A Case of Pneumomediastinum in a Patient With Acute Respiratory Distress Syndrome on Pressure Support Ventilation
JF Respiratory Care
FD American Association for Respiratory Care
SP 770
OP 773
VO 55
IS 6
A1 Véronique Leray
A1 Gael Bourdin
A1 Ghislain Flandreau
A1 Frédérique Bayle
A1 Florent Wallet
A1 Jean-Christophe Richard
A1 Claude Guérin
YR 2010
UL http://rc.rcjournal.com/content/55/6/770.abstract
AB During mechanical ventilation for acute respiratory distress syndrome, tidal volume (VT) must be reduced. Once switched to pressure-support ventilation, there is a risk that uncontrolled large VT may be delivered. A 63-year-old man with community-acquired pneumonia required tracheal intubation and mechanical ventilation, with a VT of 6 mL/kg predicted body weight, PEEP of 10 cm H2O, a respiratory rate of 30 breaths/min, and FIO2 of 0.60. Plateau pressure was 22 cm H2O. He improved and received pressure-support. Twelve days later a chest radiograph showed suspected air leaks, confirmed via computed tomogram (CT), which showed anterior pneumomediastinum. VT received over the previous 3 days had averaged 14 mL/kg predicted body weight. The patient was put back onto volume-controlled mode, and 2 days later there were no air leaks. In pressure-support ventilation, VT must be closely monitored to ensure lung-protective mechanical ventilation.