Incidence of Pneumothorax and Pneumomediastinum in Patients with Aspiration Pneumonia Requiring Ventilatory Support

Latorre, F. J. de; Klamburg, J.; León, Cristóbal; Solèr, M.; Rius, Jorge

doi:10.1378/chest.72.2.141

Cited by 87 publications

(24 citation statements)

References 10 publications

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“…Patients who received mechanical ventilation have an approximate incidence of barotrauma of 4%-15% [4,13,19,25] . It has been reported that a 14%-87% incidence of pneumothorax occurs depending on severity and duration of ARDS and mode of ventilator for management [1,21,26] .…”

Section: Epidemiologymentioning

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%

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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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Section: Epidemiologymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Iatrogenic pneumothorax related to mechanical ventilation

Hsu¹

2014

WJCCM

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“…The increasing use of such therapy however, resulted in a concomitant rise in the incidence of pulmonary barotrauma [55]. The incidence of ventilator-related pulmonary injury in ARDS may be as high as 50 % [56] and is largely related to the type of ventilation used, the use of high tidal volumes and inflationary pressures, the magnitude of peak airway pressure, the age of the patient and the presence of underlying lung disease [44,55,[57][58][59].…”

Section: B) Barotraumamentioning

confidence: 99%

Lung imaging in the adult respiratory distress syndrome: current practice and new insights

Desai¹,

Hansell²

1997

Intensive Care Med

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“…Ventilator-associated pneumothorax (VPX) is among the leading causes of iatrogenic pneumothorax [1,2], with 3-8% of mechanically ventilated patients developing pneumothorax or other forms of barotrauma [3,4,5]. VPX is the second most common cause of acute hypoxia occurring during ventilator support [6].…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Recovery of Ventilator-Associated Pneumothorax

Horng

Lin³

et al. 2012

Respiration

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Background: The usual management of ventilator-associated pneumothorax (VPX) is tube thoracostomy. However, this recommendation is based on tradition rather than on solid evidence. Although it has been applied successfully to other types of pneumothoraces, observation has not been used in the management of VPX. Objectives: In this study, we investigated whether observation is a valid treatment strategy for VPX. Methods: We retrospectively analyzed data of 471 patients with VPX (2003-2010) and found that 27 did not receive tube thoracostomy. Most of those patients (89%) had documented do-not-resuscitate orders and had refused tube thoracostomy. For comparison, 54 patients with tube thoracostomy, matched by age and do-not-resuscitate status, were chosen as controls. Among patients without tube thoracostomy, we compared attribute differences between those recovered and those not recovered. Results: Thirteen patients (48%) without tube thoracostomy experienced spontaneous recovery of their pneumothoraces. This rate of chest tube-free recovery was higher than that of patients with tube thoracostomy (48 vs. 17%; p = 0.003). The patients did not differ in in-hospital mortality rate, time to ventilator discontinuation or survival. By univariate logistic regression, spontaneous recovery was associated with VPX caused by needle puncture, lack of respiratory distress, large tidal volume and low oxygen requirement following pneumothorax, as well as by physician recommendation against intubation. Conclusion: Observation under physician surveillance is an effective option of managing many VPXs, especially those caused by needle puncture, when patients are not in respiratory distress or when patients have acceptable tidal volumes and oxygen requirements following pneumothorax.

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Incidence of Pneumothorax and Pneumomediastinum in Patients with Aspiration Pneumonia Requiring Ventilatory Support

Cited by 87 publications

References 10 publications

Iatrogenic pneumothorax related to mechanical ventilation

Iatrogenic pneumothorax related to mechanical ventilation

Lung imaging in the adult respiratory distress syndrome: current practice and new insights

Spontaneous Recovery of Ventilator-Associated Pneumothorax

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