The Macklin effect: a frequent etiology for pneumomediastinum in severe blunt chest trauma.
- Wintermark M Department of Diagnostic and Interventional Radiology, University Hospital, Lausanne, Switzerland.
- Schnyder P
- 2001-08-15
Published in:
- Chest. - 2001
Adolescent
Adult
Aged
Aged, 80 and over
Bronchi
Critical Care
Female
Humans
Length of Stay
Male
Mediastinal Emphysema
Middle Aged
Radiography, Thoracic
Thoracic Injuries
Tomography, X-Ray Computed
Trachea
Wounds, Nonpenetrating
English
STUDY OBJECTIVES
To review the etiology and pathophysiology of pneumomediastinum in severe blunt trauma, with a special interest in one of its possible origins, the Macklin effect. The Macklin effect relates to a three-step pathophysiologic process: blunt traumatic alveolar ruptures, air dissection along bronchovascular sheaths, and spreading of this blunt pulmonary interstitial emphysema into the mediastinum. The clinical relevance of the Macklin effect was also evaluated.
SETTING
A university hospital serving as a reference trauma center.
PATIENTS
A selection of 51 patients with severe blunt trauma between 1995 and 2000.
INCLUSION CRITERIA
Severe trauma or high-speed deceleration justifying chest CT; if chest CT demonstrated a pneumomediastinum, bronchoscopy and esophagoscopy were performed to rule out tracheobronchial or esophageal injury.
DESIGN
Retrospective analysis of patients' clinical files, chest CT, and bronchoscopy and esophagoscopy reports. The Macklin effect was diagnosed when an air collection adjacent to a bronchus and a pulmonary vessel could be clearly identified on the chest CT. Clinical relevance of the Macklin effect was statistically evaluated regarding its repercussions on the pulmonary gas exchange function, the respective durations of intensive care and total hospital stay, and the associated injuries.
RESULTS
Twenty (39%) Macklin effects and 5 tracheobronchial injuries (10%) were identified. One tracheobronchial injury occurred simultaneously with the Macklin effect. The presence of the Macklin effect affected neither the clinical profile nor the result of pulmonary gas analysis on hospital admission, but was associated with a significant (p < 0.001) lengthening of the intensive care stay.
CONCLUSIONS
The Macklin effect is present in 39% of severe blunt traumatic pneumomediastinum detected by CT. Its identification does not rule out a tracheobronchial injury. The Macklin effect reflects severe trauma, since it is associated with significantly prolonged intensive care stay.
To review the etiology and pathophysiology of pneumomediastinum in severe blunt trauma, with a special interest in one of its possible origins, the Macklin effect. The Macklin effect relates to a three-step pathophysiologic process: blunt traumatic alveolar ruptures, air dissection along bronchovascular sheaths, and spreading of this blunt pulmonary interstitial emphysema into the mediastinum. The clinical relevance of the Macklin effect was also evaluated.
SETTING
A university hospital serving as a reference trauma center.
PATIENTS
A selection of 51 patients with severe blunt trauma between 1995 and 2000.
INCLUSION CRITERIA
Severe trauma or high-speed deceleration justifying chest CT; if chest CT demonstrated a pneumomediastinum, bronchoscopy and esophagoscopy were performed to rule out tracheobronchial or esophageal injury.
DESIGN
Retrospective analysis of patients' clinical files, chest CT, and bronchoscopy and esophagoscopy reports. The Macklin effect was diagnosed when an air collection adjacent to a bronchus and a pulmonary vessel could be clearly identified on the chest CT. Clinical relevance of the Macklin effect was statistically evaluated regarding its repercussions on the pulmonary gas exchange function, the respective durations of intensive care and total hospital stay, and the associated injuries.
RESULTS
Twenty (39%) Macklin effects and 5 tracheobronchial injuries (10%) were identified. One tracheobronchial injury occurred simultaneously with the Macklin effect. The presence of the Macklin effect affected neither the clinical profile nor the result of pulmonary gas analysis on hospital admission, but was associated with a significant (p < 0.001) lengthening of the intensive care stay.
CONCLUSIONS
The Macklin effect is present in 39% of severe blunt traumatic pneumomediastinum detected by CT. Its identification does not rule out a tracheobronchial injury. The Macklin effect reflects severe trauma, since it is associated with significantly prolonged intensive care stay.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1378/chest.120.2.543
- PMID 11502656
- Persistent URL
- https://sonar.ch/global/documents/250865
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