Pleural Interventions: Management of Acute and Chronic Pneumothorax

Rahman, Najib M.; Davies, Robert J. O.; Gleeson, Fergus

doi:10.1055/s-2008-1081285

Cited by 9 publications

(6 citation statements)

References 70 publications

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“…In addition, hyperoxic treatment has been implicated to play a role in many other clinical conditions such as tissues hypoxia and infections in order to accelerate a tissue repair process (3). Despite this beneficial effect, high FiO 2 oxygen therapy should be used with caution in patients with secondary pneumothorax caused by cystic fibrosis, advanced bronchiectasis or chronic obstructive pulmonary disease because these patients are commonly associated with hypercapnia (6,15,22).…”

Section: Bmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Pneumothorax is a medical emergency that occurs in patients with acute lung injuries (6,14,15,22). The therapeutic options currently available for the management of pneumothorax include observation, supplementary oxygen, simple aspiration, intercostals tube drainage and video-assisted thoracoscopic surgery (15,22). Although oxygen may increase pneumothorax recovery rates, this beneficial effect is limited by the presence of short-term disadvantages as the potential long-term toxicity of unnecessary oxygen therapy (21,24).…”

Section: Introductionmentioning

confidence: 99%

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Effects of High Concentration Oxygen Treatment on Traumatic Pneumothorax in Adult Rabbits

et al. 2012

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"We undertook this study to investigate the adequate oxygen concentration that can be applied safely to the treatment of pneumothorax. Complete unilateral pneumothorax was induced artificially in rabbits, which were subsequently treated with various inspired oxygen fractions (FIO₂; 21%, 60%, 80% or 100%). The pneumothorax resolution time was measured together with the levels of IL-1β and IL-8 in broncho-alveolar lavage (BAL) and plasma samples. Furthermore, the lungs from these animals were examined for histolopathological evidence of oxygen toxicity. The results showed that the resolution time was significantly faster in the pneumothorax rabbits when treated with higher FIO₂. Significantly higher levels of IL-1 β were detected in BAL samples collected from the pneumothorax-rabbits that had received FIO₂ at levels of either 80% or 100% (P < 0.05), but not in those with FIO₂ at the 60% level. However, there was no significant change in the level of IL-8 in the BAL when the pneumothorax-rabbits were treated with different FIO₂ levels. In addition, no evidence of oxygen toxicity was found when the lung tissues were examined. The data indicated that higher FIO₂ treatment can accelerate the resolution of pneumothorax, but caution should be exercised with regard to associated oxygen toxicity when the FIO₂ used is greater than 80%. We conclude that treatment with 60% FIO₂ is an appropriate concentration for oxygen therapy for the treatment of pneumothorax in this model."

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Section: Bmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of High Concentration Oxygen Treatment on Traumatic Pneumothorax in Adult Rabbits

et al. 2012

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“…These patients are a significant management challenge and may undergo multiple and prolonged periods of drainage due to the presence of bronchopleural fistulas. 72 There are limited treatment options available for managing such cases. Attachment of a Heimlich valve to a patent chest drain may facilitate discharge from hospital and outpatient follow-up in the more stable patients.…”

Section: Patients Unfit For Surgerymentioning

confidence: 99%

Pneumothorax—Time for New Guidelines?

Hallifax

Janssen

2019

Semin Respir Crit Care Med

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Pneumothorax is a common pathology, but optimal management strategies are not yet defined. There are significant differences in international guidelines and therefore variation in clinical practice.There is increasing interest in pneumothorax research, particularly primary spontaneous pneumothorax (PSP), with evidence of lung abnormalities in this group without clinically apparent lung disease and recently completed clinical trials aiming to optimize management. The most robust evidence base is that of the equivalence of needle aspiration and chest tube insertion for initial management of PSP; although, patients with secondary spontaneous pneumothorax may also benefit. A convincing case for surgical intervention or thoracoscopy and talc poudrage to prevent recurrence at first episode in PSP has yet to be made. Clinicians should be vigilant for PSP being the first manifestation of a systemic disease, and should have a low threshold for onward referral. Time to change guidelines? First, chest tube drainage and hospitalization without recurrence prevention should no longer be standard treatment, as this has no advantage over the less invasive manual aspiration, which moreover can be performed on an outpatient basis in an important number of patients. The results of recent trials in conservative and ambulatory management are eagerly awaited. Second, shared decision-making should become more important with the well-informed patient, who may want to avoid a 1 in 3 recurrence rate and therefore will have the possibility to choose treatment including recurrence prevention even after the first episode of PSP. Third, surgical research should urgently make clear if the current practice of resection of emphysema-like changes is routinely necessary, alongside pleurodesis. Future studies should utilize risk stratification by clinical and radiological parameters (e.g., high-resolution computed tomography scanning and digital air leak monitoring) to predict short- and long-term outcomes, and hence personalize management.

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“…Current pulmonary medicine textbooks and journal reviews continue to subdivide pneumothoraces 1,2 into spontaneous pneumothoraces (SPs) and traumatic pneumothoraces, despite some confusion arising from this classification system. SPs occur without preceding trauma or obvious underlying precipitating cause.…”

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confidence: 99%

Management of Pneumothorax

Haynes

Baumann

2010

Semin Respir Crit Care Med

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Pneumothoraces are classified as spontaneous, traumatic, and iatrogenic. Spontaneous pneumothoraces (SPs) occur without recognized lung disease [primary spontaneous pneumothoraces (PSPs)] or due to an underlying lung disease [secondary spontaneous pneumothoraces (SSPs)]. Treatment of PSPs and SSPs has been heterogeneous in the United States. This heterogeneity in management is likely due in part to the fact that the American College of Chest Physicians guidelines and the British Thoracic Society guidelines differ on some management recommendations, including recommendations that pertain to simple aspiration. Traumatic pneumothoraces due to penetrating or nonpenetrating (blunt) trauma usually require the placement of a larger-bore chest tube. Iatrogenic pneumothoraces, most commonly due to transthoracic needle aspiration, may be treated in carefully selected patients with observation. The presence of underlying emphysema in the setting of an iatrogenic pneumothorax usually mandates placement of a drainage catheter.

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Pleural Interventions: Management of Acute and Chronic Pneumothorax

Cited by 9 publications

References 70 publications

Effects of High Concentration Oxygen Treatment on Traumatic Pneumothorax in Adult Rabbits

Effects of High Concentration Oxygen Treatment on Traumatic Pneumothorax in Adult Rabbits

Pneumothorax—Time for New Guidelines?

Management of Pneumothorax

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