Pulmonary barotrauma: What to know

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Pulmonary barotrauma is a potentially life threatening type of lung injury that can occur when a person experiences a sudden change in air pressure. The condition causes the presence of air where it is not typically present.

Pressure changes cause the lungs to expand beyond their typical state. This can rupture tiny air sacs (alveoli) in the lungs. The air then leaks from the alveoli and can enter blood vessels and spaces surrounding the lungs.

Excess alveolar air can lead to complications such as:

• pneumothorax, or collapsed lung
• pneumomediastinum, meaning that air is present in the space in the chest between the lungs
• subcutaneous emphysema, or air in the tissue under the skin
• arterial gas embolism, meaning there is an air bubble trapped in a blood vessel

Activities such as scuba diving can cause pulmonary barotrauma. Diving involves sudden changes in air pressure that can overexpand the lungs and damage them. As a result, gas bubbles can enter the circulatory system through small ruptured veins in the lungs.

The gas bubbles expand as the diver ascends to the surface. They can pass through arteries and obstruct the blood flow to the heart or brain.

In rare cases, flying can cause pulmonary barotrauma.

Pulmonary barotrauma may also occur as a complication of mechanical ventilation. Mechanical ventilation is a medical intervention used to support people who cannot breathe on their own or require assistance to maintain an adequate oxygen level.

The symptoms of pulmonary barotrauma can vary depending on the severity of the condition. Some of the most common symptoms are:

• chest pain
• difficulty breathing
• coughing
• wheezing
• choking
• voice changes
• difficulty swallowing
• skin that is paler than is typical
• blue- or gray-tinged skin
• respiratory failure
• loss of consciousness
• rapid heart rate
• cardiac arrest

In severe cases, pulmonary barotrauma can be fatal. Because of this, emergency treatment is critical.

A doctor will base their diagnosis of pulmonary barotrauma on the individual’s medical history, recent activities, a physical exam, and diagnostic tests.

Some tests are detailed below:

• Physical exam: This helps a doctor assess the person’s lung function. It allows them to check for any signs of lung damage, such as chest pain, shortness of breath, or abnormal sounds when listening to the chest with a stethoscope.
• Imaging studies: Certain tests, including chest radiography and CT scans, can show lung tissue damage or air pockets that have formed outside the lung.
• Arterial blood gas levels: This measures the oxygen and carbon dioxide levels in the blood. It can indicate how effectively the lungs function.
• Other tests: Ultrasonography and an electrocardiogram of the heart can show air bubbles and gas in subcutaneous tissues.

Certain tests may rule out conditions that may cause similar symptoms, such as a heart attack or a pulmonary embolism.

The treatment for pulmonary barotrauma depends on the severity of the condition and the type of injury a person has experienced. In general, treatment aims to help:

• relieve symptoms
• promote the healing of damaged lung tissue
• prevent complications

In the case of scuba-related pulmonary barotrauma, it is important to stabilize the diver with basic cardiac or more advanced life support.

For mild cases of pulmonary barotrauma, treatment may involve rest and avoiding further exposure to the activity that caused the condition. Over-the-counter pain medications, such as acetaminophen (Tylenol) or ibuprofen (Advil), can help relieve any discomfort.

In more severe cases of pulmonary barotrauma, a person may require oxygen therapy to help their lungs heal and relieve shortness of breath.

If a person has a collapsed lung, a doctor may insert a chest tube to remove excess air and allow the lung to expand.

When a person develops an arterial gas embolism or air bubble in a blood vessel, they may require higher pressure decompression in a hyperbaric dive chamber with a special breathing gas mixture called heliox. Treatment should begin within the first 2 hours. Delaying treatment for more than 6 hours can lead to worse outcomes.

Preventing pulmonary barotrauma involves minimizing the risk of sudden pressure changes in the lungs.

People should take precautions while scuba diving. This involves following safety techniques and avoiding rapid ascent to the surface. Always ascend slowly and make safety stops to allow the body to adjust.

People with chronic obstructive pulmonary disease (COPD) or asthma should not dive unless cleared to do so by a doctor.

Pulmonary barotrauma is a medical condition that can occur due to sudden changes in air pressure, causing damage to the lungs. This can happen during activities such as scuba diving, flying, or mechanical ventilation.

The symptoms of pulmonary barotrauma include chest pain, shortness of breath, coughing, and wheezing, among others. In severe cases, it can lead to a collapsed lung, cardiac arrest, or even death. This means prompt diagnosis and treatment are essential to help prevent further complications.

Doctors base the diagnosis of pulmonary barotrauma on the person’s medical history, physical exam, and diagnostic tests to rule out other conditions with similar symptoms.

Treatment options may include observation, chest tube insertion, and oxygen therapy in a decompression chamber.