A preterm infant developed bilateral tension pneumothoraces and extens
ive vascular air embolism 6 h after being commenced on nasal continuou
s positive airway pressure (CPAP). Neonatal clinicians should be aware
that catastrophic vascular air embolism could occur in infants receiv
ing nasal CPAP, a modality of respiratory support conventionally consi
dered noninvasive and 'safe'.