Subconjunctival emphysema as a complication of PEEP.

This report describes the unusual case of a four-year-old girl who developed subconjunctival emphysema as a complication of mechanical ventilatory support with high positive expiratory pressure (PEEP)--which was applied after she sustained multiple injuries in a motor vehicle accident. The patient's left lower palpebral conjunctiva ballooned outward with air collection subconjunctivally, but it was crepitant and deflatable with light pressure. Saline, garamycin ointment, and Lacrilube were used to prevent drying. The condition persisted during the period when the patient required high PEEP (more than 18 cm H2O) but resolved after PEEP was decreased to below 5 cm H2O. The patient eventually died on the 66th ventilatory day due to complications of intractable tracheobronchial fistula and Pseudomonas pneumonia.