The Relation of Pneumothorax and Other Air Leaks to Mortality in the Acute Respiratory Distress Syndrome

Objective:Pneumothorax should be considered a medical emergency and requires a high index of suspicion and prompt recognition and intervention.Aims:The objective of the study was to evaluate cases developing pneumothorax following admission to a Pediatric Intensive Care Unit (PICU) over a 5-year period.Settings and Design:Case notes of all PICU patients (n = 1298) were reviewed, revealing that 135 cases (10.4%) developed pneumothorax, and these were compared with those patients who did not. The most common tool for diagnosis used was chest X-ray followed by a clinical examination.Subjects and Methods:Case notes of 1298 patients admitted in PICU over 1-year study.Results:Patients with pneumothorax had higher mortality rate (P < 0.001), longer length of stay (P < 0.001), higher need for mechanical ventilation (MV) (P < 0.001), and were of younger age (P < 0.001), lower body weight (P < 0.001), higher pediatric index of mortality 2 score on admission (P < 0.001), higher pediatric logistic organ dysfunction score (P < 0.001), compared to their counterpart. Iatrogenic pneumothorax (IP) represented 95% of episodes of pneumothorax. The most common causes of IP were barotrauma secondary to MV, central vein catheter insertion, and other (69.6%, 13.2%, and 17.2%, respectively). Compared to ventilated patients without pneumothorax, ventilated patients who developed pneumothorax had a longer duration of MV care (P < 0.001) and higher nonconventional and high-frequency oscillatory ventilation settings (P < 0.001).Conclusions:This study demonstrated that pneumothorax is common in Alexandria University PICU patients, especially in those on MV and emphasized the importance of the strict application of protective lung strategies among ventilated patients to minimize the risk of pneumothorax.

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“…A number of studies have concluded that the incidence of barotrauma does not relate to ventilator mode. [212223]…”

Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors of pneumothorax among patients admitted to a Pediatric Intensive Care Unit

El-Nawawy

Al-Halawany

Antonios

et al. 2016

Indian Journal of Critical Care Medicine

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“…Clinical presentation of SPM includes retrosternal chest pain with radiation to the back in 90% of cases. Persistent cough is described in 42%; dysphonia, throat or jaw pain in up to 25%21 and dyspnoea in approximately 8% of cases 21. Physical examination reveals subcutaneous air in 73% of reported cases 22.…”

Section: Discussionmentioning

confidence: 99%

“…Physical examination reveals subcutaneous air in 73% of reported cases 22. Hamman's sign, although less common, is pathognomic of pneumomediastinum 21. A low-grade fever may be present and is thought to be a result of cytokine release 23.…”

Section: Discussionmentioning

confidence: 99%

Pneumomediastinum after retching

Yıldırım

Zengin

et al. 2012

Case Reports

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SummaryA 25-year-old woman with hirsutism presented to the Emergency Department of the medicine faculty in Gaziantep University with a 4-h History of dyspnoea, dysphagia, coughing, continuous and progressive chest pain radiating to the back and palpation of her neck. The physical examination was significant for diffuse neck and chest subcutaneous emphysema. The x-ray study and CT scan of the chest revealed pneumomediastinum. The patient reported that 6 h before presentation she took spironolactone due to hirsutism and she retched. Retching caused the symptoms. The patient was followed conservatively and fully recovered over the next 7 days. Spontaneous pneumomediastinum developed in this patient with no underlying lung disease, presumably from air leakage secondary to the excessive elevation of intrathoracic pressure due to retching. Pneumomediastinum is an uncommon disease arising most frequently and remains largely underdiagnosed clinically, especially in young, healthy patients. BACKGROUND

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“…Although one study showed that the incidence of pneumothorax decreased after implementation of protective lung strategies [27] , several recent studies comparing low tidal volume with conventional ventilation in ARDS failed to demonstrate any reduction in barotrauma when low tidal volumes were used [41][42][43] . Previous literature showed the incidence of barotrauma did not relate to the ventilatory settings [22,31,41,44] but a low compliance was associated with a high incidence of barotrauma, which suggested that barotrauma has been more related to the underlying process than the ventilatory setting [40] .…”

Section: Factors For Prmvmentioning

confidence: 99%

“…Pneumothorax was found to be an independent predictor of mortality during mechanical ventilation [18] and was associated with a significant increase in the ICU length of stay, hospital stay and mortality in all mechanically ventilated patients [3] . The mortality rates are high, ranging from 46% to 77% if barotrauma is a complication of mechanical ventilation [2,3,14,15,[19][20][21][22][23][24] .…”

Section: Introductionmentioning

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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The Relation of Pneumothorax and Other Air Leaks to Mortality in the Acute Respiratory Distress Syndrome

Cited by 176 publications

References 37 publications

Prevalence and risk factors of pneumothorax among patients admitted to a Pediatric Intensive Care Unit

Prevalence and risk factors of pneumothorax among patients admitted to a Pediatric Intensive Care Unit

Pneumomediastinum after retching

Iatrogenic pneumothorax related to mechanical ventilation

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