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Barotrauma related extensive pneumothorax, pneumomediastinum, and subcutaneous emphysema in a patient with acute respiratory distress syndrome with low tidal volume
  1. Jiun-I Lai1,2,
  2. Po-Chou Lin1,2,
  3. Wei-Shu Wang1,2,
  4. Shih-Chieh Chang3,
  5. Yi-Chun Lai1,2
  1. 1Department of Medicine, National Yang-Ming University Hospital, Yilan, Taiwan
  2. 2National Yang-Ming University School of Medicine, Taiwan
  3. 3Department of Chest Medicine, National Yang-Ming University Hospital, Yilan, Taiwan
  1. Correspondence to Yi-Chun Lai, Department of Medicine, National Yang-Ming University Hospital, No. 152, Xin-Min Road, Yilan 26042, Taiwan; toto881049{at}yahoo.com.tw

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An 84-year-old woman with a past history of type 2 diabetes was admitted to our hospital due to fever and worsening dyspnoea. Chest computed tomography (CT) revealed right middle lobe pneumonia with left pleural effusion (figure 1A). She was intubated because of suspected acute respiratory distress syndrome (ARDS) and treated with 100% oxygen, low tidal volume of 6 ml/kg, and high positive end expiratory pressure (PEEP) of 22 cm H2O with peak inspiratory pressure (PIP) of 30 cm H2O. Unfortunately, 2 weeks after admission, diffuse subcutaneous emphysema was noted. Chest CT (figure 1B) revealed extensive pneumomediastinum and extensive subcutaneous emphysema. PEEP was discontinued and conservative treatment with oxygen therapy and sedation was implemented. …

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