From the Guidelines
Subcutaneous emphysema should be managed conservatively, with treatment focusing on addressing the underlying cause, and in severe cases, interventions such as oxygen therapy, needle decompression, or small incisions may be necessary to release trapped air and ensure patient stability. This approach is supported by the BTS guidelines for the management of spontaneous pneumothorax, which highlight the importance of full aseptic technique in the insertion or manipulation of any chest drainage system to prevent complications such as empyema 1. The development of subcutaneous emphysema associated with pneumothorax involves an air-filled space being brought into communication with the subcutaneous tissues, which may occur due to a malpositioned, kinked, blocked, or clamped tube, or a small tube in the presence of a very large leak.
Key considerations in managing subcutaneous emphysema include:
- Identifying and treating the underlying cause
- Monitoring the patient for signs of respiratory distress or compromise
- Providing oxygen therapy as needed
- Considering needle decompression or small incisions to release trapped air in severe cases
- Maintaining aseptic technique in the management of chest drainage systems to prevent infection
The condition itself is often not dangerous but serves as an important clinical sign of potential underlying issues such as pneumothorax, tracheal injury, or esophageal perforation, which require prompt medical attention 1. Patients with subcutaneous emphysema should be assessed for respiratory distress, and if present, immediate medical intervention is necessary to prevent further complications. The pathophysiology involves air escaping from the respiratory tract or being introduced from outside the body, then dissecting along tissue planes beneath the skin, highlighting the need for careful management to prevent airway obstruction or thoracic compression.
From the Research
Definition and Causes of Subcutaneous Emphysema
- Subcutaneous emphysema is a condition where air enters the tissues under the skin, often as a result of trauma, medical procedures, or infections 2, 3, 4, 5, 6.
- It can be caused by various factors, including chest tube insertion 2, supplementary oxygen delivery through a nasopharyngeal cannula 3, surgical procedures 4, and minor cut wounds 5.
Symptoms and Diagnosis
- Symptoms of subcutaneous emphysema can range from mild to severe and may include swelling, pain, and difficulty breathing 2, 3, 4, 5.
- Diagnosis is often made using imaging studies such as computed tomography, plain radiographs, and echography, which can show the presence of air in the soft tissues 6.
Treatment and Management
- Treatment of subcutaneous emphysema depends on the severity of the condition and may include the use of subcutaneous cannulas to relieve pressure and promote drainage 2.
- Other treatment options may include hyperbaric oxygen therapy 5, manual lymphatic drainage 3, and surgical exploration to rule out underlying infections or other causes 5.
- In some cases, subcutaneous emphysema can be a sign of a more serious underlying condition, such as pneumothorax or necrotizing fasciitis, and prompt diagnosis and treatment are essential to prevent complications 6.