Monday, February 6, 2023

Barotrauma

Background

Barotrauma is an injury caused by a difference in pressure between a gas inside, in contact with, or outside the body and the pressure of the surrounding gas or fluid. Damage results from overtension or sheer forces from expansion of the gas within, or by pressure hydrostatically transmitted through, the tissues. Complications include local infiltration of gas into the damaged tissue or local circulation interfering with organ function or resulting in circulatory compromise.

This article is overview of the various types of barotrauma, such as decompression sickness, altitude sickness, medically induced barotrauma, primary blast injury, and self-inflicted barotrauma. The latter is new category and is seen in individuals using nitrous oxide as a recreational drug.

Diving as a profession can be traced back more than 5000 years, yet diving-related disease was not described until Paul Bert wrote about caisson disease in 1878. Symptoms of caisson disease were noted among bridge workers after finishing their shifts underwater and coming back to the surface. These symptoms included dizzy spells, difficulty breathing, and sharp pain in the joints or abdomen. The caisson workers often noted that they felt better while working. This was usually attributed to their being rested at the beginning of the shift as opposed to being tired when the workday was through. The workers would often have severe back pain that left them bent over, which is how caisson disease earned the nickname “the bends.”

Diving barotrauma can present with various manifestations, from ear, face or mouth pain and headaches to major joint pain, paralysis, coma, and death. As a result of the wide variety of presentations, these disorders must be considered in any patient who has recently been exposed to a significant change in barometric pressure. The three major manifestations of barotrauma include (1) sinus or middle ear effects, (2) decompression sickness (DCS), and (3) arterial gas emboli. There have also been minor sequelae to include isolated nerve involvement and facial baroparesis.
Most commonly, the sinuses and middle ear are affected, and this can occur from relatively shallow dives, from deep dives, and in diver’s training.

Barotrauma has also reportedly been caused by an airbag rupturing during deployment, forcing high-pressure gas into a person’s lungs.
It has also reportedly been associated with rapid ascent in military aircraft and with pressure changes associated with space exploration. Barotrauma has also been reported with both tracheal intubation and fiberoptic endotracheal intubation. Fiberoptic endotracheal intubation requires insufflated oxygen, which increases airway pressure. This leads to alveolar rupture with pneumothorax and subcutaneous emphysema.

The most current research in barotrauma has been dealing with ventilator-associated barotrauma and barotrauma prevention.

 

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