title: Pneumomediastinum and pneumothorax during emergency tracheotomy under spontaneous ventilation: Macklin meets Müeller?
abstract: Potentially serious complications associated to emergency tracheotomy continue being a matter of concern. We review the pathogenesis of gas leakage in this setting and discuss about the possible mechanisms involved in its cause. We present two cases of pneumomediastinum, subcutaneous emphysema and pneumothorax in the context of emergency tracheotomy under spontaneous ventilation, finally resolved by chest drainage. The combination of overly negative pleural pressures due to extreme inspiratory efforts in the context of an almost completely obstructed airway together with over-pressurized alveoli because of gaseous entrapment secondary to serious expiratory obstruction appears to be the most plausible primary cause of air leaks in our patients. Understanding the underlying mechanisms evolved in its production will help clinicians to suspect and diagnose this phenomenon.
authors.affiliation: Unidad de gestión clínica Bloque quirúrgico, Hospital General, Hospital Universitario Virgen del Rocío de Sevilla, Spain. Electronic address: mdlmattam@hotmail.com.
authors.forename: M
authors.initials: M
authors.lastname: de la Matta-Martín
authors.affiliation: Unidad de gestión clínica Bloque quirúrgico, Hospital General, Hospital Universitario Virgen del Rocío de Sevilla, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Galán
authors.affiliation: Unidad de gestión clínica Bloque quirúrgico, Hospital General, Hospital Universitario Virgen del Rocío de Sevilla, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Gallego
mesh_terms: D006801:Humans; D008478:Mediastinal Emphysema; D011030:Pneumothorax / Q000209:etiology; D011650:Pulmonary Alveoli; D013352:Subcutaneous Emphysema; D014140:Tracheotomy / Q000009:adverse effects
keywords: Barotrauma pulmonar; Emergency tracheotomy; Enfisema subcutáneo; Neumomediastino; Neumotórax; Pneumomediastinum; Pneumothorax; Pulmonary barotrauma; Subcutaneous emphysema; Traqueotomía urgente