Crucially during intrahospital transport patient-ventilator dyssynchrony generated a sudden increased excessive peak airway pressure which ruptured ill alveolus or the terminal bronchioles and then the air dissected the blood vessels travelled along the peri bronchial or perivascular sheaths and spreaded further to the pericardium subcutaneous tissues rarely peritoneum and retro peritoneum.
When patient-ventilator dyssynchrony actual peak airway pressure vary dramatically and may overshoot the upper alarm limitation of peak inspiratory pressure because of feedback mechanism delay of air feed cessation and the opening of exhalation valve.
