Macklin MT, Macklin CC (1944) Malignant interstitial emphysema of the lungs and mediastinum as an important occult complication in many respiratory diseases and other conditions: an interpretation of the clinical literature in lights of laboratory experiments. Mechanical ventilation appears to be an aggravating factor, particularly when high peak airway pressures and large tidal volumes are delivered by the ventilator.Ĭaldwell EJ, Powell RD, Mullooly JP (1970) Interstitial emphysema: a study of physiologic factors involved in experimental induction of the lesion. Underlying histologic lesions responsible for clinical lung barotrauma consist of pleural cysts, bronchiolar dilatation, alveolar overdistension and intraparenchymal pseudocysts. Patients with severe airspace enlargement (2.6–40 mm internal diameter) had a significantly greater incidence of pneumothorax (8 versus 2, p0.6, p<0.05) and lost more weight (6.3☙.2 kg versus 0.75±5.8 kg, p<0.05) than patients with mild airspace enlargement (1–2.5 mm internal diameter). Airspace enlargement, defined as the presence of either alveolar overdistension in aerated lung areas or intraparenchymal pseudocysts in nonaerated lung areas, was found in 26 of the 30 lungs examined (86%). Measurements and resultsĬlinical events and ventilatory settings used during mechanical ventilation were compared with lung histology. None of them were suspected of pre-existing emphysema. The lungs of 30 young critically ill patients (mean age 34☑0 years) were histologically examined in the immediate post-mortem period. SettingĪ 14-bed surgical intensive care unit (SICU). DesignĪssessment of histologic pulmonary barotrauma. To describe histologically pulmonary barotrauma in mechanically ventilated patients with severe acute respiratory failure.
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