Noninvasive Treatment of Pneumothorax with Oxygen Inhalation

Abstract

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.

Does oxygen therapy increase the resolution rate of primary spontaneous pneumothorax?

“…The authors suggested the faster resolution rate in the early period of oxygen therapy and the higher transpulmonary pressures in large pneumothoraces as potential mechanisms for the relation between initial pneumothorax size and resolution rate (15). Chadha et al suggested the resolution rate during oxygen supply was decreased after first 72 hours because less surface area is available for resolution (5). Our study also showed a negative correlation between the resolution rate and the time interval between radiographs.…”

“…The effects of oxygen therapy on pneumothorax have been demonstrated on theoretical grounds and in experimental studies (3,4). In two clinical studies, the resolution rate increased by three or four times during periods of oxygen therapy (5,6). However, these two studies were based on small populations with secondary pneumothorax.…”

Management of pneumothorax with oxygen therapy: a case series

“…Usually pneumothoraces less than 30% of the hemithorax have a successful outcome with supplemental oxygen administration compared to those with larger than 30% who ultimately require intercostal tube drainage. 13 All the patients in the present case series had a pneumothorax less than 30% of the pleural cavity and had a positive outcome with supplemental oxygen administration. In the experimental studies on rabbit model, there was a clear advantage demonstrated in the oxygen treated group with fraction of inspired oxygen (FiO 2 ) of 0.6 compared to the controls, in terms of the rate of resolution of the pneumothorax.…”

Complications of Pacemaker Implantation

“…Oftentimes, high concentrations of inspired oxygen can lead to a resolution of a pneumothorax that comprises less than 30% lung volume. (38) This conservative treatment of pneumothorax can reduce morbidity and duration of hospitalization and avoid invasive drainage procedures. The traditional treatment of patients with traumatic hemo-or pneumo-thoraces has been an insertion of a chest tube (CT).…”