Pathogenesis of Mediastinal Emphysema and Pneumothorax Following Tracheotomy

Bilateral pneumothorax: Perils of emergency tracheostomy

“…When significant pressure exists within these mediastinal air pockets, (which may be hastened by extrinsic factors like Intermittent Positive Pressure Ventilation IPPV), rupture into both pleural spaces is possible with resultant bilateral pneumothorax. [3,5] Padovan's experiments with cats suggested that hyperextension of the neck applies mechanical tension to the mediastinal pleura and favors bleb rupture with escape of air into the pleural space. [3] In the setting of upper airway obstruction, another contributory factor is the powerful inspiratory efforts which generate a marked negative intrathoracic pressure.…”

“…[3,5] Padovan's experiments with cats suggested that hyperextension of the neck applies mechanical tension to the mediastinal pleura and favors bleb rupture with escape of air into the pleural space. [3] In the setting of upper airway obstruction, another contributory factor is the powerful inspiratory efforts which generate a marked negative intrathoracic pressure. This negative pressure 'sucks' air rapidly from the atmosphere into the mediastinum through the edges of the tracheostomy wound and on reaching sufficient pressure ruptures through the pleura.…”

“…This negative pressure 'sucks' air rapidly from the atmosphere into the mediastinum through the edges of the tracheostomy wound and on reaching sufficient pressure ruptures through the pleura. [3] So, the resulting bilateral pneumothorax can occur as a sudden catastrophe immediately following emergency tracheostomy or acute tracheal obstruction. [4,[7][8][9] In our patient long-standing airway obstruction with marked negative intra-thoracic pressure, fibrosis of the neck tissues with difficult dissection to expose trachea and extension of neck may have led to this complication.…”

“…[2] But on the basis of autopsy evidence, few reports mention this to be a very rare cause of pneumothorax and to almost exclude pleural injury as a cause when the pneumothorax is accompanied by mediastinal emphysema. [3] This complication is more common in children. Prevalence of severe degrees of respiratory obstruction and loose areolar tissue in Bilateral pneumothorax: Perils of emergency tracheostomy children has been listed as possible causes.…”

“…Prevalence of severe degrees of respiratory obstruction and loose areolar tissue in Bilateral pneumothorax: Perils of emergency tracheostomy children has been listed as possible causes. [3] Most believe it to be due to high pleural dome in children. Bilateral pneumothorax following tracheostomy in adults is rare and herein we report such an occurrence immediately following emergency tracheostomy.…”