Pneumothorax in patients with idiopathic pulmonary fibrosis: a real-world experience

Yamazaki, Ryo; Nishiyama, Osamu; Gose, Kyuya; Saeki, Sho; Sano, Hiroyuki; Iwanaga, Takashi; Tohda, Yuji

doi:10.1186/s12890-020-01370-w

Cited by 13 publications

(18 citation statements)

References 30 publications

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“…Finally, the results of the current study can be applied only in patients with stable vital signs and not in those receiving positive mechanical ventilation. It may not be applied to patients with idiopathic pulmonary fibrosis or other interstitial lung diseases as the course of pneumothorax may be different in such underlying conditions [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of vacuum bottle plus catheter for drainage of iatrogenic pneumothorax

Chen

Kuo

et al. 2022

BMC Pulm Med

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Background Iatrogenic pneumothorax is common after thoracic procedures. For patients with pneumothorax larger than 15%, simple aspiration is suggested. Although vacuum bottle plus non-tunneled catheter drainage has been performed in many institutions, its safety and efficacy remain to be assessed. Methods Through this prospective cohort study (NCT03724721), we evaluated the safety and efficacy of vacuum bottle plus non-tunneled catheter drainage. Patients older than 20 years old who developed post-procedural pneumothorax were enrolled. A non-tunneled catheter was placed at the intersection of the midclavicular line and the second intercostal space. A 3-way stopcock, a drainage set, and a digital pressure gauge were connected. The stopcock was manipulated to connect the pleural space to the pressure gauge for measurement of end-expiration intrapleural pressure or to the vacuum bottle for air drainage. The rate of successful drainage, the end-expiration intrapleural pressure before, during, and after the procedure and the duration of hospitalization were recorded. Results From August 2018 to February 2020, 21 patients underwent vacuum bottle plus catheter drainage (intervention group) and 31 patients received conservative treatment (control group). The end-expiration intrapleural pressure of all patients remained less than − 20 cmH2O during drainage. No procedure related complication was observed. Large pneumothorax (≥ 15%) was associated with higher risk of persistent air leak (Odds ratio 12, 95% CI 1.2–569.7). Vacuum bottle assisted air drainage yielded shorter event-free duration than that of conservative treatment (2 days vs 5 days [interquartile range 1–4 days vs 3–7 days], p < .05). Vacuum bottle assisted air drainage also help identifying patients with persistent pneumothorax and necessitate the subsequent management. The event-free duration of persistent air leak in the intervention group was also comparable with that of conservative treatment (5 days vs 5 days [interquartile range 5–8 days vs 3–7 days], p = .45). Conclusions Vacuum bottle plus catheter drainage of iatrogenic pneumothorax is a safe and efficient procedure. It may be considered as an alternative management of stable post-procedural pneumothorax with size larger than 15%. Trial registration The study protocol was approved by the Research Ethics Committee of National Taiwan University Hospital (No. 201805105DINA) on 6th August, 2018. The first participant was enrolled on 23rd August, 2018 after Research Ethics Committee approval. This clinical trial complete registration at U.S. National Library of Medicine clinicaltrials.gov with identifier NCT03724721 and URL: https://clinicaltrials.gov/ct2/show/NCT03724721 on 30th October, 2018.

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of vacuum bottle plus catheter for drainage of iatrogenic pneumothorax

Chen

Kuo

et al. 2022

BMC Pulm Med

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“…The rates of pneumothorax reportedly range from 2 to 20% in patients with IPF, which is second highest to the rates occurring in patients with chronic obstructive pulmonary disease (COPD). 29 Still, more studies are needed to understand the fibrosis pathology and alveolar air leak.…”

Section: Ventilator Setting Patient S Efforts As Other Possible Etiologies Of Air Leakmentioning

confidence: 99%

“…Median tidal volume (VT) was 6.1 mL/kg predicted body weight on day 1, and the value increased significantly up to day 7, positive end-expiratory pressure was 10 cmH2O (8)(9)(10)(11)(12) on day 1, with a slight but significant decrease to day 7. Ratio of partial pressure of arterial oxygen (PaO2) to fractional inspired oxygen (FiO2) was 160 [interquartile range (IQR) 111-218], respiratory system compliance 36 mL/cmH2O (29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44), driving pressure 12 cmH2O (10)(11)(12)(13)(14), and FiO2 0.60 (0•45-0•80) on day 1. Acute respiratory distress syndrome developed in 1672 (87.6%) of patients.…”

Section: Introductionmentioning

confidence: 99%

Alveolar air leak and paraseptal emphysema in severe COVID-19 disease

Najafi¹,

Fallahian²,

Ahmadi³

et al. 2021

JMV

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Background Corona virus 2019 (COVID-19) pandemic spread in the world as a great medical crisis. Its pathophysiology, manifestations, complications, and management are not completely defined, yet. In this study frequency of alveolar air leak in critically ill COVID-19 subjects is explored. Methods A total of 820 critically ill COVID-19 subjects who admitted with respiratory insufficiency to ICUs of Sina University Hospital from March 2020 to June 2021 were included. All their chest x ray (CXR) and Computed tomography (CT) of chest were reviewed. All alveolar air leak episodes (pneumothorax, pneumomediastinum, pneumopericardium, subcutaneous emphysema) suspected films reviewed by attending intensivist and radiologist. Results Of the 820 ill COVID-19 subjects in ICUs, 492(60%) were male, and 328 (40%) were female. The Mean age of 820 subjects was 60.84 + 16.82. 584 (71.22%) of subjects were non-intubated, and 236 (28.78%) were intubated. Alveolar air leak occurred in 98 (11.95%) of subjects. Alveolar air leak episodes include pneumothorax in 26 (3.17%), subcutaneous emphysema in 72 (8.78%), pneumomediastinum in 9 (1.10%), and pneumopericardium in 1 (0.12%) of subjects. The mean age in non-intubated subjects was 59.65 + 16.84, and for intubated subjects was 63 + 16.42. There was a significant difference in age between the groups who get intubated, versus not intubated P 0.001. Of the 584 non-intubated subjects, 31 (5.31%) had subcutaneous emphysema, of the 236 intubated subjects, 41 (17.37%) had subcutaneous emphysema. Difference between groups was statistically significant, P <0.001. When we compared intubated and non-intubated patients in case of total numbers of alveolar air leak episodes, the difference was statistically significant P <0.001. Conclusion According to this study, intubation was implemented more in older patients. Also, invasive ventilation was significantly associated with subcutaneous emphysema and total number of alveolar air leak episodes. In every patient with exaggeration of hypoxia, dyspnea or chest pain, pneumothorax should be kept in mind as a differential diagnosis. Keywords: COVID-19; Respiratory failure; Alveolar air leak; Paraseptal emphysema

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“…Percutaneous CT-guided lung biopsy is a well-established technique for the diagnosis of lung cancer with a high diagnostic accuracy (83%–97%) and an acceptable complication rate (22%–51%) 9 – 15 . However, CT-guided lung biopsy in patients with UIP is challenging because of the patients’ impaired pulmonary function and high risk of pneumothorax 16 . Owing to the underlying lung fibrosis in patients with UIP, re-expansion of the lung is limited and may require chest tube drainage more frequently and for longer duration than for patients without UIP 16 .…”

Section: Introductionmentioning

confidence: 99%

“…However, CT-guided lung biopsy in patients with UIP is challenging because of the patients’ impaired pulmonary function and high risk of pneumothorax 16 . Owing to the underlying lung fibrosis in patients with UIP, re-expansion of the lung is limited and may require chest tube drainage more frequently and for longer duration than for patients without UIP 16 . A recent study evaluated the diagnostic accuracy of CT-guided percutaneous lung biopsy (fine-needle aspiration and core needle biopsy) in patients with a UIP/IPF pattern.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy and safety of CT-guided percutaneous lung biopsy with a coaxial cutting needle for the diagnosis of lung cancer in patients with UIP pattern

Kim

Sun

Kim

et al. 2022

Sci Rep

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This study aimed to assess the diagnostic accuracy and safety of CT-guided percutaneous core needle biopsy (PCNB) with a coaxial needle for the diagnosis of lung cancer in patients with an usual interstitial pneumonia (UIP) pattern of interstitial lung disease. This study included 70 patients with UIP and suspected to have lung cancer. CT-guided PCNB was performed using a 20-gauge coaxial cutting needle. The diagnostic accuracy, sensitivity, specificity, and percentage of nondiagnostic results for PCNB were determined in comparison with the final diagnosis. PCNB-related complications were evaluated. Additionally, the risk factors for nondiagnostic results and pneumothorax were analyzed. The overall diagnostic accuracy, sensitivity, and specificity were 85.7%, 85.5%, and 87.5%, respectively. The percentage of nondiagnostic results was 18.6% (13/70). Two or less biopsy sampling was a risk factor for nondiagnostic results (p = 0.003). The overall complication rate was 35.7% (25/70), and pneumothorax developed in 22 patients (31.4%). A long transpulmonary needle path was a risk factor for the development of pneumothorax (p = 0.007). CT-guided PCNB using a coaxial needle is an effective method with reasonable accuracy and an acceptable complication rate for the diagnosis of lung cancer, even in patients with UIP.

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Pneumothorax in patients with idiopathic pulmonary fibrosis: a real-world experience

Cited by 13 publications

References 30 publications

Safety and efficacy of vacuum bottle plus catheter for drainage of iatrogenic pneumothorax

Safety and efficacy of vacuum bottle plus catheter for drainage of iatrogenic pneumothorax

Alveolar air leak and paraseptal emphysema in severe COVID-19 disease

Diagnostic accuracy and safety of CT-guided percutaneous lung biopsy with a coaxial cutting needle for the diagnosis of lung cancer in patients with UIP pattern

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