[Pneumoperitoneum and pneumomediastinum complicating non-invasive ventilation].
BACKGROUND
Pneumoperitoneum is known to be a rare complication of invasive mechanical ventilation. However it has not previously been described as a consequence of non-invasive ventilation.


METHODS
The authors report a case of pneumoperitoneum associated with pneumomediastinum occurring in a 64-year-old patient treated for 3 years with bilevel ventilation via a nasal mask (expiratory pressure = 9 cm H2O, inspiratory pressure = 15 cm H2O) for obesity hypoventilation syndrome. Respiratory and gastroenterological investigations did not demonstrate a cause for this complication which resolved spontaneously following the cessation of ventilation. Nine months later, clinical deterioration and a worsening of blood gas parameters led to a recommencement of non-invasive mechanical ventilation at the same levels as previously. Over two years of follow up there have been no clinical or radiological signs of a recurrence of pneumomediastinum or pneumoperitoneum.


CONCLUSIONS
In the absence of any other explanation, barotrauma due to nasal ventilation appears to be the most likely explanation for this complication.
Planchard
D
D
Service de Pneumologie, CHU de Poitiers, Poitiers, France.
Verdaguer
M
M
Levrat
V
V
Caron
F
F
Adoun
M
M
Meurice
J C
JC
D006801:Humans; D008297:Male; D008478:Mediastinal Emphysema / Q000150:complications / Q000209:etiology*; D008875:Middle Aged; D011027:Pneumoperitoneum / Q000209:etiology*; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods