Pulmonary interstitial emphysema.

Pulmonary interstitial emphysema — a radiological and pathological correlation

“…It is known that the location of an endotracheal tube in one main bronchus may cause unilateral PIE [12] with collapse of the contralateral lung. In such circumstances selective intubation of the cotlapsed lung may be necessary in order to protect the lung with PIE from the adverse effects of high ventilatory pressures [13].…”

Pulmonary Interstitial Emphysema Presenting in a Woman on the Intensive Care Unit: Case Report and Review of Literature.

“…These include: compression atelectasis of adjacent healthy lung and resulting intrapulmonary shunt which is worsened by recruitment maneuvers; compression of surrounding pulmonary vasculature; and decompression of interstitial blebs into surrounding spaces, potentially resulting in pneumomediastinum, pneumothorax, pneumopericardium, pneumoperitoneum and surgical emphysema. Although all the above can be very difficult to manage in a critically ill patient, the addition of a pneumothorax to PIE alone doubles the mortality [1].…”

“…High-frequency ventilation (high frequency jet ventilation or high frequency oscillatory ventilation) can also be effective. Finally, extracorporeal membrane oxygenation can be used [1,2,3,8].…”

High frequency ventilation in the neonatal period

“…Heicher et al compared rates of 60/min with an inspiratory time of 0.5 s to rates of 20-40/min with an inspiratory time of I s. They found that the higher ventilator rate was associated with an significant reduction in the incidence of pneumothoraces [25]. Greenough et al [20] also reported a significant reduction in the incidence of pneumothoraces in a group of babies ventilated at higher frequencies (> 100/min) who had pulmonary interstitial emphysema (PIE) compared to another group ventilated at conventional rates. A recent multi-centre study has provided further information supporting the contention that pneumothoraces are less likely to occur if the respiratory rate is increased to the even modest level of 60/rain [29].…”