Iatrogenic Pneumothorax: Etiology and Morbidity

Abstract

The purpose of this study was to delineate the etiological factors for iatrogenic pneumothorax in the era of increased use of invasive procedures and to determine its impact on morbidity. Between 1983 and 1987 the Department of Veterans Affairs conducted a cooperative study at 13 medical centers to assess the utility of the intrapleural instillation of tetracycline for the prevention of recurrent pneumothorax. Since all patients with any type of pneumothorax were screened at each medical center, it was decided to collect data on all the iatrogenic pneumothoraces during that period. During the study period, the number of reported iatrogenic pneumothoraces were 538. Because of incomplete data, 3 iatrogenic pneumothoraces reported from one center were excluded. The leading causes of iatrogenic pneumothorax were transthoracic needle aspiration (128), subclavicular needle stick (119), thoracentesis (106), transbronchial biopsy (54), pleural biopsy (45) and positive pressure ventilation (38). Most patients required treatment for 4-7 days; however, hospitalization was prolonged due to this treatment in only 8% of patients, presumably because of their underlying disease which required long hospitalization. Patients with underlying chronic obstructive pulmonary disease required significantly longer duration of treatment than those without. We conclude that in our patient population, the three leading causes of iatrogenic pneumothorax are transthoracic needle aspiration, subclavicular needle stick and thoracentesis. Hospitalization is prolonged in only a small percentage of the patients who required treatment for the iatrogenic pneumothorax.

Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010

“…Iatrogenic pneumothorax has been shown to be even more common than spontaneous pneumothorax in several large reviews,216 217 the most common causes being transthoracic needle aspiration (24%), subclavian vessel puncture (22%), thoracocentesis (22%), pleural biopsy (8%) and mechanical ventilation (7%) 218. It is also a complication of transbronchial biopsy.…”

Ultrasound guidance reduces pneumothorax rate and improves safety of thoracentesis in malignant pleural effusion: report on 445 consecutive patients with advanced cancer

“…Iatrogenic pneumothorax resulting from thoracentesis increases morbility, mortality, and length of hospitalization. In addition, chest tube insertion may be required in up to 50% of cases, with a mean duration of placement of approximately 4 days [2,3]. Approximately 1.5 million people are found to have pleural effusion each year in the United States [4], and although thoracentesis is typically considered by physicians a relatively safe procedure with few complications [4], the incidence of pneumothorax has been reported to be as high as 20% to 39% [5].…”

Acute Pneumothorax

“…45 Iatrogenic pneumothorax on the contrary has been shown to be even more common than spontaneous pneumothorax. 46 The most common procedures being transthoracic needle aspiration (24%), subclavian vein puncture (22%), thoracentesis (22%), and mechanical ventilation (7%), all of which are frequently performed in the intensive care unit. 46 The diagnostic and management principals of a traumatic pneumothorax are similar to spontaneous pneumothorax.…”

“…46 The most common procedures being transthoracic needle aspiration (24%), subclavian vein puncture (22%), thoracentesis (22%), and mechanical ventilation (7%), all of which are frequently performed in the intensive care unit. 46 The diagnostic and management principals of a traumatic pneumothorax are similar to spontaneous pneumothorax. A chest tube drainage, however, is required in all patients on mechanical ventilation to decrease the risk of tension pneumothorax.…”