title: Unusual complication of nasal CPAP: subcutaneous emphysema following facial trauma.
abstract: Subcutaneous emphysema is an unusual complication of nasal continuous positive airway pressure (CPAP). We report a case of a 58-year-old man who fell and sustained mild facial trauma to the left side of his head. After using CPAP the following night, he developed diffuse subcutaneous emphysema of his face and left neck. He discontinued CPAP, and his symptoms improved. The potential mechanisms of this patient's subcutaneous emphysema and the prior reports of this complication following facial trauma or dental procedure without use of CPAP are reviewed. Although there are case reports of bacterial meningitis and pneumocephalus following use of nasal CPAP, we are not aware of any prior reports of subcutaneous emphysema following use of CPAP. In light of our experience and the above related case reports, we would suggest nasal CPAP be withheld temporarily in the setting of acute facial trauma.
authors.affiliation: Brown University School of Medicine, Providence, Rhode Island, USA.
authors.forename: N R
authors.initials: NR
authors.lastname: Kramer
authors.forename: M D
authors.initials: MD
authors.lastname: Fine
authors.forename: R G
authors.initials: RG
authors.lastname: McRae
authors.forename: R P
authors.initials: RP
authors.lastname: Millman
mesh_terms: D005151:Facial Injuries / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000009:adverse effects* / Q000379:methods*; D013352:Subcutaneous Emphysema / Q000209:etiology* / Q000628:therapy*