Pneumomediastinum complicated by subclavian central venous catheterization in a severe thoracic trauma patient

Pneumomediastinum is a rare event in subclavian central venous catheterization. However in severe thoracotraumatized patients, such as with bilateral hemopneumothorax, the catherization may be hazardous and made complex by occurrence pneumomediastinum, even the procedure is rightly carried out. We suggest that in such a risky condition, if it is mandatory, it should be carried out in a more placid condition, such as avoidance of high PEEP ventilation, setting lower tidal volume, or brief interruption of positive ventilation, to reduce the likelihood of unperceivable pneumomediastinum.