9. Barotrauma, pneumothorax and pneumediastinum
Air leaking problems such as pneumothorax, pneumomediastinum, and subcutaneous emphysema are more often classified as early complications of tracheostomy. Because of the anatomical differences between children and adults, children have traditionally been thought to be at high risk for these complications. These complications can be detected on postoperative chest radiographies (x-ray), and many centers routinely perform chest x-ray after tracheostomy for this reason19. Pneumothorax is one of the most common results of barotrauma, often associated with mechanical ventilation. In pediatric intensive care units, studies have shown that barotrauma and pneumothorax are linked to the duration of mechanical ventilator support and hospital stay. However, patients who experience pneumothorax have a significantly higher mortality rate compared to those who do not. This highlights the importance of careful monitoring and management of mechanical ventilation to minimize the risk of barotrauma and its potentially severe consequences. There are some opinions that argue that the incidence of barotrauma in intensive care patients is related to the underlying condition rather than ventilator settings, but there are not enough studies with this 20.
For children needing HIMV, ATS recommends regular maintenance of home ventilators and related equipment as specified by the manufacturer. Care should be taken to ensure that the actual ventilator settings seen on the ventilator monitor are consistent with the prescribed settings before the hospital discharge. Twenty-four hours a day service and telephone support should be available for mechanical breakdowns or malfunctions 1.