Case of pneumomediastinum due to alveolar rupture following endotracheal intubation

Description 

A 57-year-old woman presented to the outpatient department with complaints of shortness of breath and fever for the past 2 days. She had no known comorbidities. She was admitted in intensive care unit (ICU) in view of type 1 respiratory failure. Initial chest X-ray showed bilateral lower zone non-homogenous opacity (figure 1A). She was initially managed with antibiotics and non-invasive ventilation. However, due to worsening respiratory failure and metabolic acidosis, patient was intubated. Postintubation, patient was connected to a ventilator in volume control mode with fraction of inspired oxygen of 90%, Positive end expiratory pressure (PEEP) of 10, tidal volume of 350 mL, respiratory set rate of 20 and the ratio of duration of inspiration to the duration of expiration (I:E ratio) of 1:3.3. Chest X-ray repeated following intubation showed features suggestive of pneumomediastinum (figure 1B). The CT thorax done post intubation showed pneumoprecardium (

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