What is barotrauma in mechanical ventilation?

Updated: Apr 11, 2019
  • Author: Christopher D Jackson, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Answer

Barotrauma refers to rupture of the alveolus with subsequent entry of air into the pleural space (pneumothorax) and/or the tracking or air along the vascular bundle to the mediastinum (pneumomediastinum). The true prevalence of barotrauma is difficult to establish, but reports suggest a rate of 10%. Large tidal volumes (> 10 mL/kg) and elevated peak inspiratory and plateau pressures (Pplat > 35) are the most important risk factors. Studies in patients with adult respiratory distress syndrome (ARDS) demonstrated that the severity of the underlying lung pathology is a better predictor of barotrauma than the observed peak inspiratory pressure. Even so, peak inspiratory pressures of less than 45 mm Hg and plateau pressures of less than 30-35 mm Hg are recommended.

The inspiratory-to-expiratory ratio can be adjusted by increasing the inspiratory flow rate, by decreasing the tidal volume, and by decreasing the ventilatory rate. Attention to the inspiratory-to-expiratory ratio is important to prevent barotrauma in patients with obstructive airway disease (eg, asthma and chronic obstructive pulmonary disease). Management of barotrauma includes addressing specific complications (eg, chest tube for pneumothorax), lowering plateau pressure to less than 30 by reducing tidal volume and PEEP, and managing the underlying disorder. Barotrauma may be associated with increased mortality, although it is often not the direct cause of death.

Also see Barotrauma and Mechanical Ventilation.


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