A 66-year-old woman developed massive subcutaneous emphysema following
intubation. Acute thoracic restriction developed resulting in life-th
reatening respiratory acidosis. The patient could not be ventilated wi
th conventional means. A tracheostomy was performed to decompress the
chest and mediastinum with rapid resolution following. Although ventil
atory failure from subcutaneous emphysema is very unusual, decompressi
on with tracheostomy can be life saving.