Chest
Volume 93, Issue 6, June 1988, Pages 1301-1302
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Surgical Decompression of a Tension Pneumomediastinum: A Ventilatory Complication of Status Asthmaticus

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A case of status asthmaticus was associated with cardiorespiratory arrest, illustrating rarely reported complications of ventilatory therapy including tension pneumomediastinum and coronary air embolization. Proposed pathophysiologic mechanisms and recommendations for surgical management are discussed.

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CASE REPORT

A 23-year-old man who had been suffering from asthma for 16 years walked into the emergency department complaining of gradually worsening dyspnea of four hours' duration. He was noncompliant to therapy with both oral oxytriphylline and aerosolized salbutamol.

Laboratory values were as follows: blood pressure, 140/90 mm Hg; pulsus paradoxus, 12 mm Hg; pulse, 108 beats/min; and respirations, 26/min. No visible jugular venous distention was seen, and he was able to talk comfortably. Bilateral

DISCUSSION

The mortality of status asthmaticus is 1 percent; there is a three- to eight-fold higher incidence of barotrauma in patients given ventilatory support for this condition.3

Our patient developed well recognized complications of positive-pressure ventilation, including bilateral pneumothoraces, subcutaneous emphysema, and pneumoperitoneum.

Despite adequate decompression of his left tension pneumothorax, the patient remained in EMD and seemed to respond only to mediastinal air decompression and

REFERENCES (8)

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