Pneumothorax Complicating Continuous Ventilatory Support

Steier, M.; Ching, Nathaniel; Roberts, Enrique Bonfils; Nealon, Thomas F.

doi:10.1097/00132586-197410000-00034

Cited by 15 publications

(20 citation statements)

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“…Pneumothorax accounts for approxi mately 0.2% of all hospital admissions and is detected clinically in 0.3% of live births [2], Traumatic pneumothorax including all iatrogenic causes accounts for two-thirds of all cases of pneumothorax seen in clini cal practice [19]. Iatrogenic causes have in creased precipitously in the last decade presumably due to new diagnostic and therapeutic techniques [1].…”

Section: Introductionmentioning

confidence: 99%

Noninvasive Treatment of Pneumothorax with Oxygen Inhalation

Chadha

Cohn²

1983

Respiration

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The treatment for pneumothorax varies from invasive chest tube drainage to conservative management with bed rest. Based on the behavior of gases in closed body cavities, the inhalation of supplemental oxygen hastens absorption of the pneumothorax. To evaluate oxygen as a therapeutic agent, we treated 8 patients with pneumothoraces of various degrees with a high concentration of inspired oxygen delivered by a partial rebreathing mask. Periodic roentgenograms were used to measure the change in size of pneumothorax in order to assess the rate of resolution. 6 patients with pneumothoraces of less than 30% showed a mean resolution rate of 4.2% per day with reduction to one-third original size in the first 72 h. This was more than three times the rate of resolution (1.25% per day) previously reported with breathing room air alone. In 2 patients who initially received a lower concentration of inspired oxygen via nasal cannula, the rate of absorption increased after placing them on a partial rebreathing mask. 2 patients with four episodes of pneumothoraces greater than 30% did not benefit from this form of therapy and eventually needed chest tube drainage. We conclude that the administration of high concentrations of inspired oxygen is an effective method to enhance the rate of resolution of pneumothoraces, particularly when smaller than 30%, thereby reducing morbidity and duration of hospitalization and avoiding invasive drainage procedures.

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Section: Introductionmentioning

confidence: 99%

Noninvasive Treatment of Pneumothorax with Oxygen Inhalation

Chadha

Cohn²

1983

Respiration

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“…There have also been correlations made between high peak airway pressure and the development of pneumothorax [15,36] . High PEEP had been reported to be associated with pneumothorax [1] but several studies have found no such relationship [15,17,23,28,37] . Increased pressure is not enough by itself to produce alveolar rupture, with some studies demonstrating that pneumothorax is related to high tidal volume [37] .…”

Section: Factors For Prmvmentioning

confidence: 99%

“…High PEEP had been reported to be associated with pneumothorax [1] but several studies have found no such relationship [15,17,23,28,37] . Increased pressure is not enough by itself to produce alveolar rupture, with some studies demonstrating that pneumothorax is related to high tidal volume [37] . In animal studies, there is evidence to conclude that lung overdistension rather than high airway pressure is the primary cause of alveolar and interstitial injury [38,39] .…”

Section: Factors For Prmvmentioning

confidence: 99%

Iatrogenic pneumothorax related to mechanical ventilation

Hsu¹

2014

WJCCM

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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.

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“…O VC depende da complacência pulmonar, do gradiente de pressão (Pinsp -PEEP); em geral, utiliza-se VC de 6 a 8 ml/kg. O uso de VC altos (10 a 12 ml/kg) pode resultar em hiperdistensão alveolar e risco de síndrome de escape de ar 18,19 .…”

Section: Casuística E Métodosunclassified

Diminuição da ocorrência de pneumotórax em recém-nascidos com síndrome de desconforto respiratório através de estratégias de redução de parâmetros ventilatórios

Brunherotti

Vianna

Silveira

2003

J. Pediatr. (Rio J.)

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ResumoObjetivo: verificar, através de uma estratégia de redução dos parâmetros ventilatórios, o declínio da ocorrência de pneumotórax em recém-nascidos com síndrome do desconforto respiratório.Método: estudo longitudinal, prospectivo, em recém-nascido pré-termo com síndrome do desconforto respiratório, desenvolvido no Centro de Terapia Intensiva Infantil da Santa Casa de Misericór-dia de Franca, no período de julho de 1999 a junho de 2000. Estudouse 127 recém-nascidos com idade gestacional de 25 a 37 semanas, de ambos os sexos, e peso ao nascimento de 625g a 2.500g. Foram analisados parâmetros ventilatórios durante a assistência ventilató-ria mecânica, em dois grupos de pacientes, um controle e outro em que foram reduzidos os parâmetros ventilatórios, investigando e comparando a incidência de pneumotórax. A existência de associação entre os dados foi verificada através do teste de qui-quadrado, ao nível de significância α= 0,05 e do teste t de Student, ao nível de significância α= 0,05 e 0,01 (Sokal & Rolph,1981).Resultados: os resultados mostraram que menores parâmetros de fluxo inspiratório, tempo inspiratório, gerando menor volume corrente, diminuem a ocorrência de pneumotórax (8,1%), comparado a (24,5%) do grupo controle, com significância estatística (χ 2 = 6,545; p=0,05). Não houve significância quanto à mortalidade (χ 2 = 0,736; p=0,391).Conclusão: este estudo mostrou que a utilização de menor tempo inspiratório e fluxo inspiratório em recém-nascidos com síndrome do desconforto respiratório está associada com menor ocorrência de pneumotórax, porém não relacionada com redução da mortalidade.J Pediatr (Rio J) 2003;79(1):75-80: pneumotórax, recém-nascido, síndrome do desconforto respiratório, estratégia protetora de ventilação pulmonar. AbstractObjective: to verify if the strategy of reduction of the ventilatory parameters decreases the occurrence of pneumothorax in preterm newborns with respiratory distress syndrome.Methods: a longitudinal prospective study of preterm newborns with respiratory distress syndrome was carried out at the Pediatric Intensive Care Center of Hospital Santa Casa de Misericórdia of Franca, from July 1999 to June 2000. One hundred and twenty-seven female and male newborns between the 25 th and the 37 th week of gestation, with birthweight varying from 625 g to 2500 g were studied. The ventilatory parameters were analyzed during the assisted mechanical ventilation in two groups of patients: the controlled group and the other group, in which the parameters were reduced, by investigating and comparing the occurrence of pneumothorax. The association of data was verified through chi-square test; level of significance α = 0.05 and 0.01, and the difference among the studied parameters was obtained through the Student's t test.Results: the results show lower parameters of inhalation flow and shorter period of inhalation, generating minor tidal volume, decrease of the occurrence of pneumothorax (8.1% compared to 24.5% of the controlled group), with statistical significance (χ 2 = 6.545; p < 0...

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Pneumothorax Complicating Continuous Ventilatory Support

Cited by 15 publications

References 0 publications

Noninvasive Treatment of Pneumothorax with Oxygen Inhalation

Noninvasive Treatment of Pneumothorax with Oxygen Inhalation

Iatrogenic pneumothorax related to mechanical ventilation

Diminuição da ocorrência de pneumotórax em recém-nascidos com síndrome de desconforto respiratório através de estratégias de redução de parâmetros ventilatórios

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