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- Extra alveolar gas
- Occurs when gas under pressure causes alveolar rupture
Predisposing factors for barotraumas!
- High peak airway pressure with low end expiratory pressure
- Bullous lung disease such as may occur with emphysema or history of tuberculosis
- High levels of PEEP, with high tidal volumes
- Aspiration of gastric acid
- Necrotizing pneumonias
- The skin feel crepitant to touch
- It may be visible as puffing of the skin in the patients neck, face, or chest
- Usually occurs without complication and tends to clear without treatment as mean airways are reduced
- Can lead to compression of the esophagus, great vessels, and the heart.
- It is easily identified on chest radiograph
- Treatment depends on the severity of the problem and its effect on adjacent structures
- Can cause cardiac tamponade
- Can be detected by a resonant or hyperresonant percussion note and absence of breath sounds on the affected side, and chest radiograph will indicate lack of vascular markings on the affected side
- Treatment usually requries thoracotomy and placement of a chest tube
- Used to describe the injuries to the lungs that occur because of repeated opening and closing of lung units at lower lung volumes
- Inadequate levls of PEEP are applied
- Occurs when an alveolus that is normally expanded is adjacent to one that is collapsed
- Add PEEP
Role of PEEP in lung protection!
- Helps restore FRC by recruiting previously collapsed alveoli
- Adequate levels of PEEP prevent repeated collapse and reopening of alveoli and help maintain lung recruitment
Unintentional PEEP that occurs during mechanical ventilation
The following factors increase the risk of auto PEEP!
- Chronic obstructive airway disease
- High minute ventilation (more than 10-20 L/min) in ventilated patients
- Age greater than 60
- Increased airway resitance
- Increased lung compliance
- High respiratory frequency
- Low inspiratory flow
- Increased Vt