Pneumothorax complicating continuous ventilatory support

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

doi:10.1016/s0022-5223(19)39757-0

Cited by 125 publications

(16 citation statements)

References 7 publications

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“…e tube, however, appears to be retracted in the trachea in the radiograph taken afterwards ( Figure 4); therefore, we cannot confirm or exclude that this is the cause of pneumothorax. Although no bullae were seen in the postoperative CT scan, this does not exclude the presence of small blebs or alveolar tears, which would not always be seen on CT scans [12,14,17].…”

Section: Discussionmentioning

confidence: 90%

“…Pneumothorax during general anesthesia is a rare event, but can potentially be life threatening, especially if it develops into tension pneumothorax [11]. e major risk factor for developing pneumothorax during general anesthesia is positive pressure ventilation [12]. It is known that increasing the positive end-expiratory pressure "PEEP" increases the risk of barotrauma, especially in presence of respiratory distress syndrome (ARDS) [13].…”

Section: Discussionmentioning

confidence: 99%

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Detection and Management of Intraoperative Pneumothorax during Laparoscopic Cholecystectomy

Heyba

Rashad

Al-Fadhli

2020

Case Reports in Anesthesiology

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Intraoperative pneumothorax is a rare but potentially lethal complication during general anesthesia. History of lung disease, barotrauma, and laparoscopic surgery increase the risk of developing intraoperative pneumothorax. The diagnosis during surgery could be difficult because the signs are often nonspecific. We report a case of a middle-aged gentleman who developed right pneumothorax during an elective laparoscopic cholecystectomy. The patient had no risk factors for adverse events during the preoperative assessment (ASA1). The patient underwent general anesthesia and was put on mechanical ventilation. The first signs of abnormality immediately after surgical port insertion were tachycardia and low oxygen saturation in addition to sings of airway obstruction. The diagnosis of pneumothorax was made clinically by chest auscultation and later confirmed by intraoperative chest radiograph. Supportive treatment was started immediately through halting the surgery and manually ventilating the patient using 100% oxygen. Definitive treatment was then done by inserting an intercostal tube. After stabilizing the patient, the surgery was completed; then, the patient was extubated and shifted to the surgical ward. Postoperative computed tomography (CT) scan was done and showed only minimal liver laceration. The patient was discharged after removing the intercostal tube and was stable at the follow-up visit. Therefore, it is important to have a high index of suspicion to early detect and treat such complication. In addition, good communication with the surgeon and use of available diagnostic tools will aid in the proper management of such cases.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Detection and Management of Intraoperative Pneumothorax during Laparoscopic Cholecystectomy

Heyba

Rashad

Al-Fadhli

2020

Case Reports in Anesthesiology

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“…Pneumothorax occurs in 3-16% of mechanically ventilated patients. 53,54 Obstructive airway disease, necrotizing infections, large tidal volumes and high end-expiratory pressures all increase the risk of pneumothorax during positive pressure ventilation. The pathogenesis appears to be overdistention of emphysematous blebs or parenchyma due to the application of positive pressure to the airways.…”

Section: Barotraumamentioning

confidence: 99%

“…The application of positive end-expiratory pressures greater than 8 cm H 2 O or inadvertent intubation of the right main stem bronchus are associated with pneumothorax rates of 13-16%. 53,54 Subcutaneous emphysema and the radiographic appearance of subpleural air cysts in the interstitium are frequent harbingers of an impending pneumothorax. 55,56 Clinically, the development of a pneumothorax is often signalled by worsening cardiorespiratory distress associated with tachypnea, loss of synchrony with the ventilator, and a precipitous rise in peak and plateau pressures.…”

Section: Barotraumamentioning

confidence: 99%

Pneumothorax

Kinasewitz¹

1995

Semin Respir Crit Care Med

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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 .…”

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Decrease of the occurrence of pneumothorax in newborns with respiratory distress syndrome through reduction of ventilatory parameters

Brunherotti¹,

Vianna²,

Silveira³

2003

J Pediatr (Rio J)

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Objetivo: 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 Misericórdia 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 ventilatória 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.

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Pneumothorax complicating continuous ventilatory support

Cited by 125 publications

References 7 publications

Detection and Management of Intraoperative Pneumothorax during Laparoscopic Cholecystectomy

Detection and Management of Intraoperative Pneumothorax during Laparoscopic Cholecystectomy

Pneumothorax

Decrease of the occurrence of pneumothorax in newborns with respiratory distress syndrome through reduction of ventilatory parameters

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