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As the term suggests, the lung injury associated with barotrauma is mediated by increased alveolar pressures.Improved understanding of the mechanisms underlying VILI and barotrauma makes it imperative for physicians to adjust ventilator settings to prevent alveolar overdistention.

It is now evident, however, that barotrauma represents only one of the mechanisms underlying the broad category of ventilator-induced lung injury (VILI).

On the other hand, transalveolar pressure, a measure of alveolar distention, provides another indication of the risk of barotrauma.

The concept is the same, with overdistended alveoli leading to disruption in the alveolar epithelium and decompression of air as previously outlined.

This gradient may result in rupture of the alveoli adjacent to the perivascular sheath, with ensuing passage of air into the perivascular sheath, and proximal dissection into the mediastinum. In persons with PIE, alveolar air is further decompressed by dissecting along lines of least resistance.

These pathways include subcutaneous tissues, where the air produces subcutaneous emphysema, or along tissue planes, resulting in pneumopericardium, pneumoperitoneum, or subpleural air cysts.

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