The incidence of ventilator-induced pulmonary barotrauma in critically ill patients

Abstract

Pulmonary barotrauma (pneumothorax, pneumomediastinum or subcutaneous emphysema) reportedly occurs in 10 per cent (range 4-18 per cent) of patients who need mechanical ventilation with or without the use of positive end-expiratory pressure (PEEP). To document the impression that the incidence of pulmonary barotrauma was lower than those in previously reported series, the authors retrospectively examined the charts of 200 consecutive critically ill patients for pulmonary barotrauma and evaluated those factors that might have contributed to its occurrence. The patients ranged in age from 18 to 95 years. Central venous pressure catheters had been used in 168 patients, and 178 patients were ventilated with a volume-cycled ventilator. Durations of ventilation averaged six days. The highest peak inspiratory pressures averaged 38±12 (1 SD) cm H2O, although in 60 patients, peak inspiratory pressures exceeded 40 cm H2O. Mean dynamic compliance was 29.6±13.8 ml/cm H2O. Many patients needed more than 40 hours of ventilation with 3->12 cm H2O PEEP. While 22 of these patients showed evidence of barotrauma at some time during hospitalization, barotrauma was definitely unrelated to mechanical ventilation in 16, and probably unrelated in five more patients. In only one case was there a definite relationship between the use of mechanical ventilation and the development of pulmonary barotrauma, for an overall incidence of 0.5 per cent.