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Pulmonary interstitial emphysema almost exclusively occurs as a result of positive pressure ventilation with peak airway pressures exceeding 30 cm[H.
The initial abnormal air collection in barotrauma is pulmonary interstitial emphysema (PIE), most often identified in children.
1,14) In cases of spontaneous pneumomediastinum during labor, it is believed that alveolar rupture secondary to a rapid increase in air pressure in the alveoli leads to pulmonary interstitial emphysema.