%0 Journal Article
%T Pulmonary interstitial emphysema presenting in a woman on the intensive care unit: case report and review of literature
%A Peter B Sherren
%A Tomas Jovaisa
%J Journal of Medical Case Reports
%D 2011
%I BioMed Central
%R 10.1186/1752-1947-5-236
%X An 87-year-old Caucasian woman with a diagnosis of community-acquired pneumonia was admitted to our intensive care unit requiring invasive ventilation. The combination of a poor oxygenation index and bilateral alveolar/interstitial infiltrates on a chest radiograph fulfilled the criteria for adult respiratory distress syndrome; the cause was thought to be a combination of the direct pneumonic pulmonary injury and extrapulmonary severe sepsis. By day seven, the fraction of inspired oxygen, peak airway and positive end expiratory pressures weaned sufficiently to allow an uncomplicated percutaneous tracheostomy. On day 10, problems with ventilation necessitated recruitment maneuvers with a Mapleson C circuit, after which dramatic surgical emphysema was noted. An upper airway bronchoscopy showed no obvious tracheal wall injury, and computed tomography of her chest showed extensive surgical emphysema, perivascular emphysema and peribronchial emphysema, which were consistent with a diagnosis of pulmonary interstitial emphysema. Over the following days, despite protective ventilatory strategies and intercostal tube thoracostomy, lung compliance along with oxygenation deteriorated and our patient died on day 14.The development of pulmonary interstitial emphysema is a rare but real risk when caring for patients with worsening lung compliance on the intensive care unit. Improved awareness of the condition, early protective ventilation strategies and timely treatment of any of the lethal complications will hopefully result in improved survival from the condition in adults.Pulmonary interstitial emphysema (PIE) is a barotrauma-related life-threatening condition, not uncommon to the neonatologist caring for pre-term babies. For the intensivist, despite being confronted by significant compliance issues resulting from the fibroproliferative phase of adult respiratory distress syndrome (ARDS) on a daily basis, PIE in the critically ill adult is an extremely rare occurrence. The inf
%U http://www.jmedicalcasereports.com/content/5/1/236