Pneumothorax as a complication of bilevel positive airway pressure (BiPAP) ventilation

Objectives: To describe the complication of pneumothorax in two paediatric patients receiving bilevel positive airway pressure (BiPAP) ventilation for respiratory insufficiency. Design: Two patient case report. Setting: Tertiary pediatric ICU. Subjects: Two adolescents ages 12 and 16. Interventions: BiPAP ventilation for respiratory insufficiency and tube thoracostomy for pneumothorax. Measurements and main results: Both of our patients had a common underlying pathology of inflammatory lung disease and difficulty clearing airway secretions. Both patients displayed signs, symptoms, and radiographic findings consistent with pneumothorax after receiving BiPAP ventilation. The air leak resolved in our patients after chest tube placement without additional complications. Conclusion: The medical literature reports BiPAP to be an effective and safe mode of providing non-invasive positive pressure ventilatory support. In patients with acute inflammatory pulmonary processes and the inability to clear secretions, pneumothorax is a potential complication.