Clinical manifestations of tension pneumothorax: protocol for a systematic review and meta-analysis

Abstract

BackgroundAlthough health care providers utilize classically described signs and symptoms to diagnose tension pneumothorax, available literature sources differ in their descriptions of its clinical manifestations. Moreover, while the clinical manifestations of tension pneumothorax have been suggested to differ among subjects of varying respiratory status, it remains unknown if these differences are supported by clinical evidence. Thus, the primary objective of this study is to systematically describe and contrast the clinical manifestations of tension pneumothorax among patients receiving positive pressure ventilation versus those who are breathing unassisted.Methods/DesignWe will search electronic bibliographic databases (MEDLINE, PubMed, EMBASE, and the Cochrane Database of Systematic Reviews) and clinical trial registries from their first available date as well as personal files, identified review articles, and included article bibliographies. Two investigators will independently screen identified article titles and abstracts and select observational (cohort, case–control, and cross-sectional) studies and case reports and series that report original data on clinical manifestations of tension pneumothorax. These investigators will also independently assess risk of bias and extract data. Identified data on the clinical manifestations of tension pneumothorax will be stratified according to whether adult or pediatric study patients were receiving positive pressure ventilation or were breathing unassisted, as well as whether the two investigators independently agreed that the clinical condition of the study patient(s) aligned with a previously published tension pneumothorax working definition. These data will then be summarized using a formal narrative synthesis alongside a meta-analysis of observational studies and then case reports and series where possible. Pooled or combined estimates of the occurrence rate of clinical manifestations will be calculated using random effects models (for observational studies) and generalized estimating equations adjusted for reported potential confounding factors (for case reports and series).DiscussionThis study will compile the world literature on tension pneumothorax and provide the first systematic description of the clinical manifestations of the disorder according to presenting patient respiratory status. It will also demonstrate a series of methods that may be used to address difficulties likely to be encountered during the conduct of a meta-analysis of data contained in published case reports and series. PROSPERO registration number: CRD42013005826.

A Rare Complication Caused by Dry Needling Method: Tension Pneumothorax

“…Tension pneumothorax results in deterioration of cardiopulmonary function due to displacement of the mediastinal structures. Chest pain, dyspnea, respiratory distress, hypoxia, tachypnea, tachycardia, hypotension, jugular venous distension, contralateral tracheal deviation, respiratory and cardiac arrest occur in these patients (8)(9)(10). In our case, tracheal deviation and the displacement of mediastinal structures were not apparent.…”

“…Signs and symptoms of pneumothorax are dyspnea, tachypnea, chest pain, dry cough, cyanosis, and the absence or reduction of respiratory sounds on auscultation in the affected area. Tension pneumothorax, which is often encountered in prehospital areas, the emergency room, or the intensive care unit, is a rare but fatal condition without early diagnosis and treatment (9,10). Tension pneumothorax results in deterioration of cardiopulmonary function due to displacement of the mediastinal structures.…”

A Rare Complication of Cardiopulmonary Resuscitation: Tension Pneumothorax

“…Tension pneumothorax is an uncommon condition with a high mortality rate most frequently reported to occur in prehospital, emergency department, and intensive care unit (ICU) settings [2][3][4][5]. This condition is frequently lethal in injured and ventilated ICU patients without early diagnosis and treatment [6][7][8].…”

“…This condition is frequently lethal in injured and ventilated ICU patients without early diagnosis and treatment [6][7][8]. Although the incidence of tension pneumothorax remains poorly estimated, it may occur in up to 1% to 3% of prehospital, major trauma and ICU patients [2,4]. Tension pneumothorax is a well known complication of intermittent-positivepressure ventilation (IPPV) and chronic lung disease.…”

Oncological Airway Emergencies in the Critical Care Unit

“…Tension pneumothorax, as seen with mechanical ventilation or cardiopulmonary resuscitation, is a medical emergency. The incidence has not been definitively established, and statistical analysis is in its infancy [55]. Reports in adult ICUs have been as high as 3% [56].…”