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Overview of Barotrauma

By

Richard E. Moon

, MD, Duke University Medical Center

Last full review/revision Jun 2021| Content last modified Jun 2021
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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 affects the lungs and gastrointestinal (GI) tract; during descent, gas compression affects 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 3 to 4 feet below the surface (eg, when scuba gear is used there) and, rarely, from an inverted bucket.

Symptoms

Diagnosis

  • 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

  • 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 Barotrauma is tissue injury caused by a pressure-related change in body compartment gas volume. It can affect the ear (causing ear pain, hearing loss, and/or vestibular symptoms) or the sinuses... read more , 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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