Alveolar and pleural rupture. Hazards of positive pressure respiration

POSITIVE pressure pulmonary inflation has been used by the anesthetist for many decades. More recently, with the advent of the respirator the principle has been commonly used on the wards and in the recovery room. It is also an essential part of modern, aggressive methods of resuscitation, both in the delivery room in asphyxic newborn infants and on the general wards following cardiac arrest. Positive pressure respiration is not without hazards. This has been emphasized by a number of case reports in the literature of the past 50 years, and several investigative studies are at hand to elucidate the pathogenesis involved. It is the purpose of this communication not only to call renewed attention to the possibility of iatrogenic alveolar or pleural rupture with their frequently disastrous consequences but also to point out that these complications are likely to go unrecognized because they are masked by the very circumstances bringing