A 35-year-old woman was admitted to the intensive care unit with acute exacerbation of obstructive airway disease and received mechanical ventilation for 3 days. After clinical improvement, she was extubated, and noninvasive ventilation (NIV) was started because of high arterial CO2 levels. She was receiving NIV via an oronasal mask. After 12 h of NIV use, she had an increase in dyspnea and complained of abdominal pain and distention. On clinical examination, she was in marked respiratory distress. She had abdominal distension, and an outline of the distended stomach was seen on the abdomen [Figure 1]. In view of the worsening respiratory failure, she was intubated and started on invasive mechanical ventilation. A nasogastric tube was placed, and a gush of air came from the tube, which led to the resolution of abdominal distension.
Figure 1.
Clinical photograph of the patient demonstrating outline of the distended stomach due to aerophagia
NIV is commonly used in intensive care units and emergency rooms for the management of acute respiratory failure.[1] It is considered a safe modality when used judiciously for appropriate indications. Common complications of NIV therapy include mask-related complications such as pressure injuries, aspiration, mucous plugging, aerophagia, and gastric distension.[2] Aerophagia is common during NIV use and can worsen the respiratory failure due to impaired diaphragmatic movements due to distended stomach. Gastric distension also increases the risk of aspiration pneumonia. The use of nasogastric tubes in these patients helps in stomach decompression, but can sometimes increase the leak from the mask. A regular clinical examination can help identify this early, leading to timely treatment.
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REFERENCES
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