Pneumomediastinum and pneumothorax in acute respiratory distress syndrome (ARDS) patients: a narrative review

Yi Xiang Teo; Harinivaas Shanmugavel Geetha; Ajay Kumar Mishra; Amos Lal

doi:10.21037/med-23-39

Pneumomediastinum and pneumothorax in acute respiratory distress syndrome (ARDS) patients: a narrative review

Mediastinum. 2023 Dec 12:8:3. doi: 10.21037/med-23-39. eCollection 2024.

Authors

Yi Xiang Teo¹, Harinivaas Shanmugavel Geetha¹, Ajay Kumar Mishra², Amos Lal³

Affiliations

¹ Department of Medicine, Saint Vincent Hospital, Worcester, MA, USA.
² Division of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA, USA.
³ Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.

Abstract

Background and objective: Acute respiratory distress syndrome (ARDS) is a severe, life-threatening medical condition characterized by poor oxygenation due to non-compliant lungs secondary diffuse alveolar damage. Encouragingly, the incidence of ARDS has declined steadily recently, attributed mainly to implementation of keystone guidelines and continuous research efforts. Mechanical ventilation is the cornerstone of supportive care for ARDS patients. This review aims to consolidate the current knowledge on pneumothorax (PNX) and pneumomediastinum (PMD) and to enhance the understanding of the readers. The objectives are to (I) explore the etiology and risk factors of PNX and PMD, (II) discuss the various diagnostic modalities available, (III) evaluate management options, and (IV) recent advancements.

Methods: A search of the literature was conducted using PubMed, MEDLINE, and Google Scholar for relevant articles pertaining to PNX and PMD in ARDS population. The clinical presentation, diagnostic and management strategies of PNX, PMD, and ARDS were summarized, and all authors reviewed the selection and decide which studies to include.

Key content and findings: The adoption of lung-protective ventilation strategies, based on the review of literature from the recent years, shows that it has played a significant role in reducing the occurrence of barotrauma, such as PNX and PMD. However, PNX and PMD remains to be a challenging complication to manage. With a specific focus on PNX and PMD, this review provides valuable insights into effectively managing and understanding these critical complications among ARDS patients.

Conclusions: ARDS, with its evolving definition, continues to pose a life-threatening threat. Despite the widespread adoption of lung-protective ventilation strategies, PNX and PMD present persistent challenges in management. Further research is imperative to enhance the risk assessment of ARDS patients prone to developing PNX and PMD and to institute more effective prevention and treatment measures.

Keywords: Acute respiratory distress syndrome (ARDS); barotrauma; coronavirus disease 2019 (COVID-19); pneumomediastinum (PMD); pneumothorax (PNX).

Publication types

Review