title: Pneumomediastinum following hyperbaric oxygen therapy for carbon monoxide poisoning: case report.
abstract: A 5-year-old boy trapped in a house fire was transported to the emergency department, unconscious with suspected carbon monoxide poisoning. The patient underwent a difficult intubation, but did not initially demonstrate any radiographic abnormalities. The patient remained intubated and underwent hyperbaric oxygen therapy using the carbon monoxide treatment protocol. Immediate post-therapy chest radiograph revealed the development of occult pneumomediastinum. The patient remained stable on positive-pressure ventilation and the pneumomediastinum resolved spontaneously. The patient was extubated on post-injury Day #2 and was discharged post-injury Day #4 with no residual clinical sequelae. The development of pneumomediastinum associated with hyperbaric oxygen therapy for carbon monoxide poisoning appears to be a rare phenomenon. However, clinicians should be aware of the risk factors that predispose patients to developing pneumomediastinum and have a low threshold for obtaining routine pre- and post-procedure screening chest radiographs in intubated and critically ill patients, particularly in children.
authors.affiliation: University of Nevada School of Medicine, Division of Plastic Surgery, Las Vegas, Nevada, USA. jjnolan@medicine.nevada.edu
authors.forename: Nolan J
authors.initials: NJ
authors.lastname: Jaeger
authors.affiliation: University of Nevada School of Medicine, Division of Plastic Surgery, Las Vegas, Nevada, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Brosious
authors.affiliation: University Medical Center of Southern Nevada, Hyperbaric Medicine Center, Las Vegas, Nevada, USA.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Gustavson
authors.affiliation: University Medical Center of Southern Nevada, Hyperbaric Medicine Center, Las Vegas, Nevada, USA.
authors.forename: Chad A
authors.initials: CA
authors.lastname: McFarlin
authors.affiliation: University of Maryland Medical Center, Hyperbaric Medicine Department, Baltimore, Maryland, USA.
authors.forename: William
authors.initials: W
authors.lastname: Gearhart
authors.affiliation: University of Nevada School of Medicine, Division of Plastic Surgery, Las Vegas, Nevada, USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Zamboni
authors.affiliation: University of Nevada School of Medicine, Division of Plastic Surgery, Las Vegas, Nevada, USA.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Baynosa
mesh_terms: D002249:Carbon Monoxide Poisoning / Q000628:therapy*; D002675:Child, Preschool; D005390:Fires; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000009:adverse effects*; D008297:Male; D008478:Mediastinal Emphysema / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D011175:Positive-Pressure Respiration; D011859:Radiography