[A paracardiac sickle-shaped air mass following the insertion of a Swan-Ganz catheter--iatrogenic or caused by barotrauma?].
We report a 20-year-old male with severe injuries (head, multiple fractures, contusion of the left lung) who developed the adult respiratory distress syndrome (ARDS) on the 3rd day of treatment. The patient was ventilated as follows: FiO2 1.0; rate 14/min; minute ventilation 17 1/min; PEEP 10 cm H2O; peak inspiratory pressure 44 mmHg; mean pressure 31 mmHg. A Swan-Ganz catheter was inserted via the left subclavian vein. Because of dysfunction, this catheter had to be removed. A new Swan-Ganz catheter was inserted by the same route (no other central vein came into question because of massive swelling of the neck and inflammation of the skin). The post-cannulation chest radiograph showed bilateral paracardial air shadows for the first time. Two and 4 hours later the pneumomediastinum had diminished somewhat. During this time period the circulation and pulmonary function remained stable; no catecholamines had to be administered and artificial ventilation did not need to be changed. Post-mortem examination showed no injury to the trachea. It is concluded that the pneumomediastinum without subcutaneous emphysema was caused by a spontaneous mediastinal pneumothorax as a result of barotrauma at the time of insertion of a Swan-Ganz catheter.
Heinze
J
J
Klinik für Anaesthesiologie, Universität Tübingen.
Röder
H U
HU
D000328:Adult; D001469:Barotrauma / Q000209:etiology*; D002407:Catheterization, Swan-Ganz / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008478:Mediastinal Emphysema / Q000209:etiology*; D011030:Pneumothorax / Q000209:etiology*
Parakardiale Luftsichel nach Insertion eines Swan-Ganz-Katheters--iatrogen oder durch Barotrauma verursacht?