A case of pneumomediastinum in a patient with acute respiratory distress syndrome on pressure support ventilation

Respir Care. 2010 Jun;55(6):770-3.


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.

Publication types

  • Case Reports

MeSH terms

  • Humans
  • Male
  • Mediastinal Emphysema / complications*
  • Mediastinal Emphysema / diagnostic imaging
  • Mediastinal Emphysema / etiology*
  • Middle Aged
  • Positive-Pressure Respiration / adverse effects*
  • Positive-Pressure Respiration / standards
  • Respiration, Artificial / adverse effects*
  • Respiratory Distress Syndrome / complications*
  • Respiratory Distress Syndrome / therapy*
  • Tomography, X-Ray Computed