Acute and Critical Care

Case Report

Neurosurgery
What should an intensivist know about pneumocephalus and tension pneumocephalus?: Bhushan Sudhakar Wankhade, Maged Mohsen Kamel Beniamein, Zeyad Faoor Alrais, Jyoti Ittoop Mathew, Ghaya Zeyad Alrais; Acute Crit Care. 2023;38(2):244-248. Published online April 13, 2022; DOI: https://doi.org/10.4266/acc.2021.01102

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Collection of air in the cranial cavity is called pneumocephalus. Although simple pneumocephalus is a benign condition, accompanying increased intracranial pressure can produce a life-threatening condition comparable to tension pneumothorax, which is termed tension pneumocephalus. We report a case of tension pneumocephalus after drainage of a cerebrospinal fluid hygroma. The tension pneumocephalus was treated with decompression craniotomy, but the patient later died due to the complications related to critical care. Traumatic brain injury and neurosurgical intervention are the most common causes of pneumocephalus. Pneumocephalus and tension pneumocephalus are neurosurgical emergencies, and anesthetics and intensive care management like the use of nitrous oxide during anesthesia and positive pressure ventilation have important implications in their development and progress. Clinically, patients can present with various nonspecific neurological manifestations that are indistinguishable from a those of a primary neurological condition. If the diagnosis is questionable, patients should be investigated using computed tomography of the brain. Immediate neurosurgical consultation with decompression is the treatment of choice.

Citations

Citations to this article as recorded by

Occurrence of postoperative pneumoencephalus in posterior fossa surgery using the semi-sitting position: Prevalence, factors and patterns
Liezel Ulloque-Caamaño, Mario Gomar-Alba, Benjamin Romero-Leguina, Nadin J. Abdala-Vargas, Juan F. Villalonga, Álvaro Campero
Neurocirugía (English Edition).2026; : 500763. CrossRef
Otogenic pneumocephalus from an unrecognized mastoid defect
Ummi Humaira Zulkeply, Iffah Salim, Mohd Khairi Md Daud
Visual Journal of Emergency Medicine.2026; 43: 102481. CrossRef
Fatal postoperative tension pneumocephalus after acute subdural hematoma evacuation: a case report
Nikolaos Gkantsinikoudis, Panagiotis Monioudis, Elias Antoniades, Vassilios Tsitouras, Ioannis Magras
International Journal of Neuroscience.2025; 135(11): 1237. CrossRef
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David Hao, Kirk Bonner, Taylor Burnham, Milan P. Stojanovic
Anesthesia & Analgesia.2025; 141(1): 103. CrossRef
A case of cerebrospinal fluid (CSF) leak and pneumocephalus in a 52-year-old with a pituitary adenoma
Barbara Magid, Lauren Titone, Tyler Wise
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Yasir H Elhassan, Mustafa Alhasan, Yasser S Abdulghani
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Mehdi Hekimoğlu, Hıdır Özer
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Kaavya Venkatesh, Nitin Mukerji, Devasmitha Venkataraman
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Atraumatic Tension Pneumocephalus in a Shunted Patient: A Case of Rapid Neurological Decline
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Yasser Hegazy, Natalie N Balassiano, Ishank Gupta, Roger Stern, Muhammad Ghallab
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Goran Latif Omer, Riccardo Maurizi, Beatrice Francavilla, Kareem Rekawt Hama Rashid, Gianluca Velletrani, Hasan Mustafa Salah, Giulia Marzocchella, Mohammed Ibrahim Mohialdeen Gubari, Stefano Di Girolamo, Rong-San Jiang
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Original Article

Pulmonary
Evaluation of Respiratory Dynamics in an Asymmetric Lung Compliance Model: So Hui Yun, Ho-Jin Lee, Yong-Hun Lee, Jong Cook Park; Korean J Crit Care Med. 2017;32(2):174-181. Published online April 14, 2017; DOI: https://doi.org/10.4266/kjccm.2016.00738

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Abstract PDF

Background
Unilateral lung hyperinflation develops in lungs with asymmetric compliance, which can lead to vital instability. The aim of this study was to investigate the respiratory dynamics and the effect of airway diameter on the distribution of tidal volume during mechanical ventilation in a lung model with asymmetric compliance.
Methods
Three groups of lung models were designed to simulate lungs with a symmetric and asymmetric compliance. The lung model was composed of two test lungs, lung1 and lung2. The static compliance of lung1 in C15, C60, and C120 groups was manipulated to be 15, 60, and 120 mL/cmH₂O, respectively. Meanwhile, the static compliance of lung2 was fixed at 60 mL/cmH₂O. Respiratory variables were measured above (proximal measurement) and below (distal measurement) the model trachea. The lung model was mechanically ventilated, and the airway internal diameter (ID) was changed from 3 to 8 mm in 1-mm increments.
Results
The mean ± standard deviation ratio of volumes distributed to each lung (V_L1/V_L2) in airway ID 3, 4, 5, 6, 7, and 8 were in order, 0.10 ± 0.05, 0.11 ± 0.03, 0.12 ± 0.02, 0.12 ± 0.02, 0.12 ± 0.02, and 0.12 ± 0.02 in the C15 group; 1.05 ± 0.16, 1.01 ± 0.09, 1.00 ± 0.07, 0.97 ± 0.09, 0.96 ± 0.06, and 0.97 ± 0.08 in the C60 group; and 1.46 ± 0.18, 3.06 ± 0.41, 3.72 ± 0.37, 3.78 ± 0.47, 3.77 ± 0.45, and 3.78 ± 0.60 in the C120 group. The positive end-expiratory pressure (PEEP) of lung1 was significantly increased at airway ID 3 mm (1.65 cmH₂O) in the C15 group; at ID 3, 4, and 5 mm (2.21, 1.06, 0.95 cmH₂O) in the C60 group; and ID 3, 4, and 5 mm (2.92, 1.84, 1.41 cmH₂O) in the C120 group, compared to ID 8 mm (p < 0.05).
Conclusions
In the C15 and C120 groups, the tidal volume was unevenly distributed to both lungs in a positive relationship with lung compliance. In the C120 group, the uneven distribution of tidal volume was improved when the airway ID was equal to or less than 4 mm, but a significant increase of PEEP was observed.

Citations

Citations to this article as recorded by

Proof-of-concept study of compartmentalized lung ventilation using system for asymmetric flow regulation (SAFR)
Igor Barjaktarevic, Glen Meyerowitz, Onike Williams, I. Obi Emeruwa, Nir Hoftman
Frontiers in Medical Technology.2023;[Epub] CrossRef
Is It Essential to Consider Respiratory Dynamics?
Youngjoon Kang
The Korean Journal of Critical Care Medicine.2017; 32(2): 223. CrossRef

Case Report

A Case of Severe Acute Exacerbation of Bronchial Asthma Treated with Low Minute Ventilation: A Case Report: Young Joo Han, Dong In Suh, Young Seung Lee, June Dong Park; Korean J Crit Care Med. 2010;25(4):257-262.; DOI: https://doi.org/10.4266/kjccm.2010.25.4.257

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Abstract PDF: We report a case of severe status asthmaticus in a 3-year-old boy who required mechanical ventilatory support. He initially presented with rapidly progressing respiratory distress and spontaneous air leaks. Although he was intubated and received mechanical ventilation, dynamic hyperinflation and air leaks were aggravated. We applied the volume control mode, providing sufficient tidal volume (10 ml/kg), a reduced respiratory rate (25/minute), and a prolonged expiratory time (1.8 seconds) to overcome dynamic hyperinflation. After allowing full expiration of trapped air, his over-expanded lung volumes were decreased and the air leaks resolved. He made a complete recovery without sequelae. Dynamic hyperinflation in asthmatic patients occurs from incomplete exhalation throughout narrowed airways. Controlled hypoventilation or permissive hypercapnia is an important lung-protective ventilator strategy and is beneficial in reducing dynamic hyperinflation. We suggest a controlled hypoventilation strategy with a prolonged expiratory time for patients in severe status asthmaticus with dynamic hyperinflation.

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