![]() Mechanical ventilation may determine alveolar rupture, which results in air leakage into extra-alveolar interstitium. Barotrauma can be a complication of mechanical ventilation, either invasive (IV) or non-invasive (NIV), and may be associated with increased morbidity and mortality. Pulmonary barotrauma is defined as the presence of extra alveolar air due to lung injury. Mechanical positive pressure ventilation is the most common treatment for acute respiratory failure (ARF) it can be delivered through a noninvasive (nasal or face mask, nasal plugs), or an invasive interface (endotracheal tube, tracheostomy). The clinical spectrum of SARS-CoV-2 pneumonia ranges from mild to critically ill cases and morbidity and mortality is largely due to acute respiratory distress syndrome (ARDS) as described in early reports from Wuhan about 30 % of patients with COVID-19 required mechanical ventilation. No more signs of barotrauma were present. Parenchymal changes were still present with GGO and areas of irregular, mild consolidation (Fig 3). Pneumomediastinum had dramatically reduced no more soft tissue emphysema and PIE were seen.Ī contrast CT scan at day 30 ruled out pulmonary embolism. The second CT at day 19 showed the same range of parenchymal involvement, characterized by irregular bands of dense consolidation (Fig 2). A score of lung parenchymal involvement was estimated visually from 50 to 75%. Diffuse ground-glass opacities (GGO) were present bilaterally in all lobes (Fig 1c) with areas of “crazy paving” increased density and consolidations with a prevalent subpleural distribution. Air (Fig 1b, arrow) consistent with pulmonary interstitial emphysema (PIE) was seen along with peribronchovascular bundles. The first CT at day 10 showed pneumomediastinum with air decompressing along cervical fascial planes into subcutaneous tissue (Fig 1a). During hospitalization three chest CTs were performed.
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