From the Research
Management of adult pneumomediastinum primarily involves conservative treatment with close observation, rest, analgesia, and oxygen therapy, as most cases resolve within 7-10 days without specific interventions 1. The goal of treatment is to alleviate symptoms, prevent complications, and allow the body to resorb the air in the mediastinum.
- Patients should be admitted for observation for 24-48 hours to monitor for potential complications, such as mediastinitis or tension pneumomediastinum 2.
- Oxygen therapy (2-4 L/min via nasal cannula) helps accelerate air resorption from the mediastinal space, and pain management typically includes acetaminophen (1000 mg every 6 hours) or NSAIDs like ibuprofen (400-600 mg every 6-8 hours) 3.
- Activities that increase intrathoracic pressure, such as coughing, vomiting, or strenuous physical exertion, should be avoided to prevent worsening of the condition 4.
- Antibiotics are not routinely indicated unless there is evidence of infection, and surgical intervention is rarely needed but may be considered for severe cases with mediastinitis, tension pneumomediastinum, or persistent air leaks 5.
- Follow-up chest imaging is recommended after 1-2 weeks to confirm resolution of the pneumomediastinum 3. The conservative approach is effective because the thin mediastinal pleura allows air to be gradually resorbed into the bloodstream, and most cases are self-limiting without long-term sequelae 1.