Introduction:
Pneumomediastinum produced by barotrauma is a possible complication from
the mechanical ventilation, since the positive pressure produces
alveolar rupture. The incidence is variable, and increases according to
the indication of mechanical ventilation (1). In a prospective study
with 5183 ICU patients, the overall incidence was 2.9%, reaching 6.5%
in patients with acute respiratory distress syndrome (ARDS)(2). The
incidence is higher in invasive ventilation than in non-invasive
ventilation (NIV) or continuous positive airway pressure (CPAP).
Barotrauma risk can be diminished with protective measures, such as
using low support pressure and reduced tidal volumes (1,3).
During the health crisis caused by the COVID-19 coronavirus pandemic, a
high percentage of the severe patients (up to 15.6% in a review of 1099
patients in Wuhan, China) had respiratory distress (7). In the context
of respiratory failure the first step is conventional oxygen therapy.
Secondly, if it’s available, the High-flow Nasal Cannulas (HFNC). And
finally invasive or non invasive ventilation (NIV). This last one should
not postpone intubation (8).
We present the case of a patient with COVID19 positive who, after
starting an NIV, suffered a pneumomediastinum and subcutaneous
emphysema.