title: A case of pneumomediastinum in a patient with acute respiratory distress syndrome on pressure support ventilation.
abstract: During mechanical ventilation for acute respiratory distress syndrome, tidal volume (V(T)) must be reduced. Once switched to pressure-support ventilation, there is a risk that uncontrolled large V(T) may be delivered. A 63-year-old man with community-acquired pneumonia required tracheal intubation and mechanical ventilation, with a V(T) of 6 mL/kg predicted body weight, PEEP of 10 cm H2O, a respiratory rate of 30 breaths/min, and F(IO2) of 0.60. Plateau pressure was 22 cm H2O. He improved and received pressure-support. Twelve days later a chest radiograph showed suspected air leaks, confirmed via computed tomogram (CT), which showed anterior pneumomediastinum. V(T) received over the previous 3 days had averaged 14 mL/kg predicted body weight. The patient was put back onto volume-controlled mode, and 2 days later there were no air leaks. In pressure-support ventilation, V(T) must be closely monitored to ensure lung-protective mechanical ventilation.
authors.affiliation: Service de Réanimation Médicale, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Leray
authors.forename: Gael
authors.initials: G
authors.lastname: Bourdin
authors.forename: Ghislain
authors.initials: G
authors.lastname: Flandreau
authors.forename: Frédérique
authors.initials: F
authors.lastname: Bayle
authors.forename: Florent
authors.initials: F
authors.lastname: Wallet
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Richard
authors.forename: Claude
authors.initials: C
authors.lastname: Guérin
mesh_terms: D006801:Humans; D008297:Male; D008478:Mediastinal Emphysema / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology*; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000009:adverse effects* / Q000592:standards; D012121:Respiration, Artificial / Q000009:adverse effects*; D012128:Respiratory Distress Syndrome / Q000150:complications* / Q000628:therapy*; D014057:Tomography, X-Ray Computed