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Overview of Barotrauma

By

Richard E. Moon

, MD, Duke University Medical Center

Reviewed/Revised Apr 2023
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Barotrauma is tissue injury caused by a pressure-related change in body compartment gas volume in air-containing areas. During ascent, gas expansion can affect the lungs and gastrointestinal (GI) tract; during descent, gas compression can affect ears, sinuses, air spaces in tooth fillings, and space contained by the diving face mask. Manifestations depend on the affected area. Diagnosis is clinical but sometimes requires imaging tests. Treatment generally is supportive but may include oxygen and chest tube placement for pneumothorax Pneumothorax Pneumothorax is air in the pleural space causing partial or complete lung collapse. Pneumothorax can occur spontaneously or result from trauma or medical procedures. Diagnosis is based on clinical... read more Pneumothorax .

Risk of barotrauma (often called "squeeze" by divers) is greatest from the surface to 10 m (33 ft). Risk is increased by any condition that can interfere with equilibration of pressure (eg, sinus congestion, eustachian tube blockage, structural anomaly, infection) in the air-containing spaces of the body.

In divers who inspire even a single breath of air or other gas at depth and do not let it escape freely during ascent, or when ascent is rapid, the expanding gas may overinflate the lungs, causing pulmonary barotrauma Pulmonary Barotrauma Barotrauma is tissue injury caused by a pressure-related change in body compartment gas volume. Factors increasing risk of pulmonary barotrauma include certain behaviors (eg, rapid ascent, breath-holding... read more . Lung overinflation occurs mostly in divers breathing compressed air but can occur even in swimming pools when compressed air is inspired at depths 1 m (3 to 4 ft) below the surface (eg, when scuba gear is used there).

Symptoms and Signs of Barotrauma

Manifestations depend on the affected area; all occur almost immediately when pressure changes. Symptoms may include ear pain, vertigo, hearing loss, sinus pain, epistaxis, and abdominal pain. Dyspnea and alteration or loss of consciousness can be life threatening and may result from alveolar rupture and pneumothorax Pneumothorax Pneumothorax is air in the pleural space causing partial or complete lung collapse. Pneumothorax can occur spontaneously or result from trauma or medical procedures. Diagnosis is based on clinical... read more Pneumothorax .

Some medical disorders, if they cause symptoms at depth, may be disabling or disorienting and thus lead to drowning Drowning Drowning is respiratory impairment resulting from submersion in a liquid medium. It can be nonfatal (previously called near drowning) or fatal. Drowning results in hypoxia, which can damage... read more (see table ). Secondary infection is sometimes a late complication.

Diagnosis of Barotrauma

  • Clinical evaluation

  • Imaging tests

Diagnosis is primarily clinical; imaging tests can sometimes confirm barotrauma. Sometimes patients are evaluated for other problems or organ dysfunction.

Treatment of Barotrauma

  • Symptomatic treatment

  • Other treatment dependent on specific injury

  • Neurologic symptoms or signs, including altered consciousness

  • Dyspnea

  • Peritoneal signs

  • Abnormal vital signs

Initial stabilizing treatment includes high-flow 100% oxygen and, if respiratory failure appears imminent, endotracheal intubation Tracheal Intubation Most patients requiring an artificial airway can be managed with tracheal intubation, which can be Orotracheal (tube inserted through the mouth) Nasotracheal (tube inserted through the nose)... read more . Positive pressure ventilation may cause or exacerbate pneumothorax.

When stable, patients are treated for the specific type of barotrauma sustained. For patients with inner ear barotrauma Ear and Sinus Barotrauma , prompt surgical treatment of labyrinthine window tears can reverse hearing loss.

Patients treated for severe or recurrent diving-related injuries should not return to diving until they have consulted with a diving medicine specialist.

Key Points

More Information

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

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NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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