{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T12:13:40Z","timestamp":1776082420995,"version":"3.50.1"},"reference-count":11,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,9,30]],"date-time":"2022-09-30T00:00:00Z","timestamp":1664496000000},"content-version":"vor","delay-in-days":272,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acute Medicine &amp; Surgery"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>In patients with coronavirus disease (COVID\u201019) due to severe acute respiratory syndrome coronavirus 2 infection, pneumomediastinum has been increasingly reported in cases of noninvasive oxygen therapy, including high\u2010flow nasal cannula, and invasive mechanical ventilation. However, its pathogenesis is still not understood.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case Presentation<\/jats:title><jats:p>We report two cases of pneumomediastinum in acute respiratory distress syndrome (ARDS) caused by COVID\u201019. In both cases, control of spontaneous breathing with neuromuscular blocking agents resulted in resolution of pneumoperitoneum.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The improvement of pneumomediastinum with control of spontaneous breathing suggested patient self\u2010inflicted lung injury as a possible mechanism in this case series. In ARDS cases with pneumomediastinum, in addition to controlling plateau pressure with conventional lung protective ventilation, spontaneous breathing should be controlled if the patient\u2019s inspiratory effort is suspected to be strong.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ams2.796","type":"journal-article","created":{"date-parts":[[2022,10,1]],"date-time":"2022-10-01T03:50:31Z","timestamp":1664596231000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Pneumomediastinum as patient self\u2010inflicted lung injury in patients with acute respiratory distress syndrome due to <scp>COVID<\/scp>\u201019: a case series"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6266-2091","authenticated-orcid":false,"given":"Rika","family":"Watanabe","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Sapporo Medical University School of Medicine  Hokkaido Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3272-7680","authenticated-orcid":false,"given":"Ryuichi","family":"Nakayama","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Sapporo Medical University School of Medicine  Hokkaido Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3605-402X","authenticated-orcid":false,"given":"Naofumi","family":"Bunya","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Sapporo Medical University School of Medicine  Hokkaido Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naoya","family":"Yama","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology Sapporo Medical University School of Medicine  Sapporo Hokkaido Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yusuke","family":"Iwamoto","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Sapporo Medical University School of Medicine  Hokkaido Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoichi","family":"Katayama","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Sapporo Medical University School of Medicine  Hokkaido Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takehiko","family":"Kasai","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Sapporo Medical University School of Medicine  Hokkaido Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keigo","family":"Sawamoto","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Sapporo Medical University School of Medicine  Hokkaido Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuji","family":"Uemura","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Sapporo Medical University School of Medicine  Hokkaido Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eichi","family":"Narimatsu","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Sapporo Medical University School of Medicine  Hokkaido Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,9,30]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.4007"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202105-1179IM"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2021.02.008"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202008-3376IM"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.102.2.568"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201605\u20101081CP"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmcr.2021.101455"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1005372"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201912-2512OC"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1939.00190050019003"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.4329\/wjr.v6.i11.850"}],"container-title":["Acute Medicine &amp; 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