From the Guidelines
Subcutaneous emphysema should be managed by immediately addressing the underlying cause, such as unclamping a chest tube if it is clamped, and providing supportive care, including oxygen therapy and pain management, as the condition itself is not usually dangerous but indicates an underlying pathology that requires prompt evaluation and treatment. When managing subcutaneous emphysema, it is crucial to identify and address the source of air leakage, which may include pneumothorax, tracheal/bronchial injury, or barotrauma. According to the BTS guidelines for the management of spontaneous pneumothorax 1, if a patient with a clamped drain becomes breathless or develops subcutaneous emphysema, the drain must be immediately unclamped and medical advice sought. Key considerations in the management of subcutaneous emphysema include:
- Identifying and addressing the underlying cause of air leakage
- Providing supportive care, including oxygen therapy and pain management
- Monitoring respiratory status, including oxygen saturation and work of breathing
- Considering chest tube placement or subcutaneous drains for moderate to severe cases
- Recognizing that subcutaneous emphysema itself is not usually dangerous but serves as an important clinical sign of an underlying pathology that requires prompt evaluation and treatment, as indicated by the BTS guidelines 1.
From the Research
Subcutaneous Emphysema Management
- Subcutaneous emphysema is a condition where air escapes into the subcutaneous tissue, often as a complication of chest tube insertion or other medical procedures 2, 3.
- The management of subcutaneous emphysema can vary depending on the severity of the condition, with mild cases often requiring no specific treatment, while more severe cases may require intervention to prevent complications such as airway obstruction and respiratory failure 3, 4.
- Several studies have reported the use of subcutaneous drains or cannulas as a effective method for managing severe subcutaneous emphysema, with benefits including rapid decompression and significant symptom relief 2, 5.
- Other management approaches, such as infraclavicular incisions, have also been reported to be effective in reducing the severity of subcutaneous emphysema and improving patient outcomes 4.
- In some cases, subcutaneous emphysema can be a delayed complication of medical procedures, such as tracheal intubation, and may require aggressive treatment, including subcutaneous exhaust and thoracic closed drainage 6.
Factors Contributing to Subcutaneous Emphysema
- Several factors can contribute to the development of subcutaneous emphysema, including the presence of a pneumothorax, chronic obstructive pulmonary disease (COPD), and iatrogenic causes such as chest tube insertion or surgery 3, 4.
- The severity of subcutaneous emphysema can also be influenced by the size of the air leak, with larger air leaks associated with more severe cases of subcutaneous emphysema 3.
Treatment Outcomes
- The outcomes of treatment for subcutaneous emphysema can vary depending on the severity of the condition and the management approach used, with some studies reporting significant improvements in symptoms and quality of life following treatment 2, 4, 5.
- Further research is needed to fully understand the etiology and management of subcutaneous emphysema, particularly in cases where the condition is a delayed complication of medical procedures 6.