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Barotrauma Pneumomediastinum — FRCA Final MCQ

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ModerateIntensive Care MedicineBarotrauma PneumomediastinumFRCA Final

A ventilated ICU patient develops progressive subcutaneous emphysema in the neck and chest. CXR shows bilateral pneumomediastinum. What is the most likely source?

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Correct answer: C — Alveolar rupture from barotrauma

Progressive subcutaneous emphysema + pneumomediastinum in a ventilated patient = barotrauma from alveolar rupture (Macklin effect). Air tracks along perivascular sheaths to mediastinum then subcutaneous tissues. Risk factors: high airway pressures, ARDS, overdistension. Reduce airway pressures, check for associated pneumothorax.

Reference: ICS/BTS – 2023 – Barotrauma in mechanical ventilation