Marini J J, Culver B H
University of Minnesota, Minneapolis-St. Paul.
Ann Intern Med. 1989 May 1;110(9):699-703. doi: 10.7326/0003-4819-110-9-699.
Most forms of barotrauma related to mechanical ventilation are known to occur in both adult and pediatric patients. The pressure-driven transfer of gas from the alveolar compartment to the systemic circulation, a devastating complication of ventilatory support in infants, is not generally recognized as a consequence of ventilatory support in adults. Two young adult patients who received ventilatory support with high levels of positive pressure for pneumonia and the adult respiratory distress syndrome developed massive sub-pleural air cysts, interstitial emphysema, and tension pneumothoraces. Despite receiving appropriate treatment for these problems, the patients had recurrent episodes of cerebral infarction, myocardial injury, and a characteristic pattern of livedo reticularis. This distinctive triad of findings, otherwise unexplained and occurring in the setting of cystic barotrauma, is highly suggestive of systemic gas embolism. Although our patients presented with dramatic clinical features, we believe that patients with ventilator-related gas embolism may present more commonly with subtler signs, such as puzzling disturbances in heart rhythm or mental status, seizure activity, hypotension, localized pain, or other embolic manifestations readily ascribed to other causes in critically ill patients.
大多数与机械通气相关的气压伤在成人和儿科患者中均有发生。气体从肺泡腔向体循环的压力驱动转移，这是婴儿通气支持的一种毁灭性并发症，一般不被认为是成人通气支持的后果。两名因肺炎和成人呼吸窘迫综合征接受高水平正压通气支持的年轻成年患者出现了大量胸膜下气囊、间质性肺气肿和气胸。尽管针对这些问题接受了适当治疗，但患者仍反复出现脑梗死、心肌损伤以及特征性的网状青斑。这一独特的三联征表现，在囊性气压伤的情况下无法用其他原因解释，强烈提示存在系统性气体栓塞。尽管我们的患者表现出显著的临床特征，但我们认为，与呼吸机相关的气体栓塞患者可能更常见地表现为更细微的体征，如心律或精神状态的莫名紊乱、癫痫发作、低血压、局部疼痛，或其他在重症患者中容易归因于其他原因的栓塞表现。
