Pneumothorax: an update

Abstract

Pneumothorax is a relatively common clinical problem which can occur in individuals of any age. Irrespective of aetiology (primary, or secondary to antecedent lung disorders or injury), immediate management depends on the extent of cardiorespiratory impairment, degree of symptoms and size of pneumothorax. Guidelines have been produced which outline appropriate strategies in the care of patients with a pneumothorax, while the emergence of video-assisted thoracoscopic surgery has created a more accessible and successful tool by which to prevent recurrence in selected individuals. This evidence based review highlights current practices involved in the management of patients with a pneumothorax.

Does oxygen therapy increase the resolution rate of primary spontaneous pneumothorax?

“…The purposes of oxygen therapy for PSP are to maintain oxygen saturation and to increase the resolution rate. It is generally accepted that oxygen therapy increases the resolution rate of pneumothorax (1,2). The theoretical basis is that oxygen therapy reduces the partial pressure of nitrogen in the alveolus compared with the pleural cavity, and a diffusion gradient for nitrogen accelerates resolution (3,10).…”

“…It is widely accepted that oxygen therapy increases the resolution rate of spontaneous pneumothorax (1,2). The effects of oxygen therapy on pneumothorax have been demonstrated on theoretical grounds and in experimental studies (3,4).…”

Iatrogenic pneumothorax related to mechanical ventilation

“…Reduction in tidal volume during pressure controlled ventilation and increased airway pressure with volume controlled ventilation might be found from ventilators. A pulsus paradoxus on the arterial trace and increased central venous pressure from central venous catheterization may be observed [8,9,46,47] . It should be noted that many of the above findings are nonspecific and have not been a reliable indicator of pneumothorax given that dyspnea severity can be out of proportion to the size of the pneumothorax.…”

“…Examination of the respiratory and cardiovascular systems may help establish the diagnosis of pneumothorax. However, examination findings may vary according to the size of pneumothorax and presence of limited cardiorespiratory reserve [47] , with patients with a small pneumothorax (one involving < 15% of the hemithorax) possibly having a normal physical examination. Careful inspection and repeated auscultation of the chest is therefore crucial.…”

Management of pneumothorax with oxygen therapy: a case series

“…Treatment strategies include observation, oxygen therapy, needle aspiration or intercostal chest tube (ICT) insertion. 1 Oxygen therapy is useful in the treatment of traumatic 2 and spontaneous pneumothorax 3 where it is found to be safe, efficacious and associated with reduced length of hospital stay. Hospitalised cases of pneumothorax who are not subjected to needle aspiration and ICT drainage, due to any reason, may be managed with supplemental oxygen therapy administered at high concentrations.…”