Kramer N R, Fine M D, McRae R G, Millman R P
Brown University School of Medicine, Providence, Rhode Island, USA.
Sleep. 1997 Oct;20(10):895-7.
Subcutaneous emphysema is an unusual complication of nasal continuous positive airway pressure (CPAP). We report a case of a 58-year-old man who fell and sustained mild facial trauma to the left side of his head. After using CPAP the following night, he developed diffuse subcutaneous emphysema of his face and left neck. He discontinued CPAP, and his symptoms improved. The potential mechanisms of this patient's subcutaneous emphysema and the prior reports of this complication following facial trauma or dental procedure without use of CPAP are reviewed. Although there are case reports of bacterial meningitis and pneumocephalus following use of nasal CPAP, we are not aware of any prior reports of subcutaneous emphysema following use of CPAP. In light of our experience and the above related case reports, we would suggest nasal CPAP be withheld temporarily in the setting of acute facial trauma.
皮下气肿是鼻持续气道正压通气（CPAP）一种不常见的并发症。我们报告一例58岁男性，其摔倒后左侧头部遭受轻度面部创伤。在次日夜间使用CPAP后，他出现面部和左侧颈部弥漫性皮下气肿。他停用CPAP后症状改善。本文回顾了该患者皮下气肿的潜在机制以及此前在未使用CPAP的面部创伤或牙科手术后出现此并发症的报道。虽然有使用鼻CPAP后发生细菌性脑膜炎和气颅的病例报告，但我们未发现此前有使用CPAP后出现皮下气肿的报道。根据我们的经验及上述相关病例报告，我们建议在急性面部创伤情况下暂时停用鼻CPAP。
