• Nolan J Jaeger, John P Brosious, Richard B Gustavson, Chad A McFarlin, William Gearhart, William A Zamboni, and Richard C Baynosa.
• University of Nevada School of Medicine, Division of Plastic Surgery, Las Vegas, Nevada, USA. jjnolan@medicine.nevada.edu
• Undersea Hyperbar M. 2013 Nov 1; 40 (6): 521-3.

AbstractA 5-year-old boy trapped in a house fire was transported to the emergency department, unconscious with suspected carbon monoxide poisoning. The patient underwent a difficult intubation, but did not initially demonstrate any radiographic abnormalities. The patient remained intubated and underwent hyperbaric oxygen therapy using the carbon monoxide treatment protocol. Immediate post-therapy chest radiograph revealed the development of occult pneumomediastinum. The patient remained stable on positive-pressure ventilation and the pneumomediastinum resolved spontaneously. The patient was extubated on post-injury Day #2 and was discharged post-injury Day #4 with no residual clinical sequelae. The development of pneumomediastinum associated with hyperbaric oxygen therapy for carbon monoxide poisoning appears to be a rare phenomenon. However, clinicians should be aware of the risk factors that predispose patients to developing pneumomediastinum and have a low threshold for obtaining routine pre- and post-procedure screening chest radiographs in intubated and critically ill patients, particularly in children.

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