Iatrogenic pneumothorax related to mechanical ventilation

Abstract

ral space prevents sonographic visualization of visceral pleura movements. Mechanically ventilated patients with a pneumothorax require tube thoracostomy placement because of the high risk of tension pneumothorax. Small-bore catheters are now preferred in the majority of ventilated patients. Furthermore, if there are clinical signs of a tension pneumothorax, emergency needle decompression followed by tube thoracostomy is widely advocated. Patients with pneumothorax related to mechanical ventilation who have tension pneumothorax, a higher acute physiology and chronic health evaluation Ⅱ score or PaO2/FiO2 < 200 mmHg were found to have higher mortality.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved. Key words: Barotrauma; Complication; Critical care; Mechanical ventilation; PneumothoraxCore tip: Patients with pneumothorax related to mechanical ventilation (PRMV) have a high mortality rate. PRMV often occurs in the early stage of mechanical ventilation and it may recur on the other side of lung in a short period of time. Low compliance is associated with a high incidence of PRMV, with PRMV being more related to the underlying process than the ventilatory setting. PRMV patients with tension pneumothorax, higher acute physiology and chronic health evaluation score or PaO2/FiO2 < 200 mmHg have a higher mortality.Hsu CW, Sun SF. Iatrogenic pneumothorax related to mechanical ventilation.

Pleural Puncture that Excludes the Ablation Zone Decreases the Risk of Pneumothorax after Percutaneous Microwave Ablation in Porcine Lung

“…Mechanical ventilation is known to induce barotrauma with an incidence of 4%–15% (20,21). Ventilator-associated pneumothorax is related to rupturing of the alveoli with dissection of air into the intrapleural space.…”

“…In animal studies, there is evidence that transalveolar pressure and alveolar overdistention, rather than high airway pressure, are the primary causes of barotrauma and ventilator-induced lung injury (21,22). Pneumothorax is unusual in intubated patients with normal lungs, and most patients with pneumothorax related to mechanical ventilation have underlying pulmonary disease, most often acute respiratory distress syndrome in which the lung is physiologically small with low compliance (20). Thermal ablation induces an acute injury to the lung that may mimic acute pulmonary pathology; combining thermal ablation and mechanical ventilation likely has a multiplicative effect on the risk of pneumothorax.…”

Post Operative Pulmonary Complications Following Surgery for Congenital Heart Disease

“…In mechanical ventilated patients pneumothorax is not uncommon. Moreover underlying lung diseases and low compliance of lung are associated with ventilatorrelated pneumothorax with pneumothoraces occurring most commonly during the early phase of mechanical ventilation 20,21 .…”

Lung Ultrasound: The Emerging Role of Respiratory Therapists

“…54,57,58 Many of the clinical subjective and objective findings are nonspecific and are not considered to be reliable indicators of pneumothorax. 59 Imaging techniques remain the accepted standard for the recognition of pneumothorax. 60 In the ICU, most patients are in a supine or semi-recumbent position, and anterior-posterior chest radiograph films are often obtained, limiting the reliability of chest radiographs.…”