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.