P Rehospital R Ecognition of T Ension P Neumothorax

Friend, Kevin D.

doi:10.1080/10903120090941704

Cited by 10 publications

(2 citation statements)

References 4 publications

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“…Case reports of tension pneumothorax in spontaneously breathing patients are remarkably rare. Leigh‐Smith and Harris could identify only 18 cases to which can be added six recent reports . Of these 24, nine had primary spontaneous pneumothorax but did not have classical clinical signs of tension pneumothorax and were diagnosed because of the radiological appearances of mediastinal shift.…”

Section: Case Reportsmentioning

confidence: 99%

Spontaneous tension pneumothorax: what is it and does it exist?

Simpson

Vincent

Ferns

2012

Internal Medicine Journal

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Tension pneumothorax is variously defined but is generally thought of as a pneumothorax in which the pressure of intrapleural gas exceeds atmospheric pressure, producing adverse effects, including mediastinal shift associated with cardiovascular collapse, often attributed to reduced venous return and kinking of the great vessels. The mechanism of tension pneumothorax is said to be a valvular defect in the visceral pleura such that air enters the pleural space in inspiration but cannot exit in expiration, leading to a progressive increase in pressure. However, as the driving pressure forcing air into the pleura in inspiration is atmospheric pressure, the pleural pressure can never exceed 1 atm during inspiration in a spontaneously breathing subject. Furthermore, all pneumothoraces must have pressures greater than atmospheric during expiration, or conventional treatment with intercostal tube drainage would not work. Pilot experiments have failed to show any re-entry of pleural gas into the lung in patients with persistent air leaks but no evidence of tension, suggesting these behave as valvular pneumothoraces. Case reports of tension pneumothorax in spontaneously breathing patients are rare, and most patients have other explanations for clinical deterioration. Although a large and rapidly expanding pneumothorax may require urgent intervention, it is unlikely that the effects are mediated by high intrapleural pressures. The term tension pneumothorax in spontaneously breathing patients should be reconsidered.

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Section: Case Reportsmentioning

confidence: 99%

Spontaneous tension pneumothorax: what is it and does it exist?

Simpson

Vincent

Ferns

2012

Internal Medicine Journal

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“…Further, if our results support the pathophysiologic differences observed among animal studies of tension pneumothorax, it may also allow for the creation of separate definitions for the condition according to the presenting respiratory status of the patient. As delay in treatment of tension pneumothorax may adversely affect outcomes, and some clinicians may delay thoracic decompression among those suspected of having the condition as their hemodynamics are stable [65], this study could also potentially assist in identifying patients who may be appropriate candidates for treatment with needle or tube thoracostomy.…”

Section: Discussionmentioning

confidence: 99%

Clinical manifestations of tension pneumothorax: protocol for a systematic review and meta-analysis

et al. 2014

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BackgroundAlthough health care providers utilize classically described signs and symptoms to diagnose tension pneumothorax, available literature sources differ in their descriptions of its clinical manifestations. Moreover, while the clinical manifestations of tension pneumothorax have been suggested to differ among subjects of varying respiratory status, it remains unknown if these differences are supported by clinical evidence. Thus, the primary objective of this study is to systematically describe and contrast the clinical manifestations of tension pneumothorax among patients receiving positive pressure ventilation versus those who are breathing unassisted.Methods/DesignWe will search electronic bibliographic databases (MEDLINE, PubMed, EMBASE, and the Cochrane Database of Systematic Reviews) and clinical trial registries from their first available date as well as personal files, identified review articles, and included article bibliographies. Two investigators will independently screen identified article titles and abstracts and select observational (cohort, case–control, and cross-sectional) studies and case reports and series that report original data on clinical manifestations of tension pneumothorax. These investigators will also independently assess risk of bias and extract data. Identified data on the clinical manifestations of tension pneumothorax will be stratified according to whether adult or pediatric study patients were receiving positive pressure ventilation or were breathing unassisted, as well as whether the two investigators independently agreed that the clinical condition of the study patient(s) aligned with a previously published tension pneumothorax working definition. These data will then be summarized using a formal narrative synthesis alongside a meta-analysis of observational studies and then case reports and series where possible. Pooled or combined estimates of the occurrence rate of clinical manifestations will be calculated using random effects models (for observational studies) and generalized estimating equations adjusted for reported potential confounding factors (for case reports and series).DiscussionThis study will compile the world literature on tension pneumothorax and provide the first systematic description of the clinical manifestations of the disorder according to presenting patient respiratory status. It will also demonstrate a series of methods that may be used to address difficulties likely to be encountered during the conduct of a meta-analysis of data contained in published case reports and series. PROSPERO registration number: CRD42013005826.

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Tension Pneumothorax Managed Without Immediate Needle Decompression

Chan

2009

The Journal of Emergency Medicine

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P Rehospital R Ecognition of T Ension P Neumothorax

Cited by 10 publications

References 4 publications

Spontaneous tension pneumothorax: what is it and does it exist?

Spontaneous tension pneumothorax: what is it and does it exist?

Clinical manifestations of tension pneumothorax: protocol for a systematic review and meta-analysis

Tension Pneumothorax Managed Without Immediate Needle Decompression

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