Principles of diagnosis and management of traumatic pneumothorax

Abstract

Presence of air and fluid with in the chest might have been documented as early as Fifth Century B.C. by a physician in ancient Greece, who practiced the so-called Hippocratic succession of the chest. This is due to a development of communication between intrapulmonary air space and pleural space, or through the chest wall between the atmosphere and pleural space. Air enters the pleural space until the pressure gradient is eliminated or the communication is closed. Increasing incidence of road traffic accidents, increasing awareness of healthcare leading to more advanced diagnostic procedures, and increasing number of admissions in intensive care units are responsible for traumatic (noniatrogenic and iatrogenic) pneumothorax. Clinical spectrum of pneumothorax varies from asymptomatic patient to life-threatening situations. Diagnosis is usually made by clinical examination. Simple erect chest radiograph is sufficient though; many investigations are useful in accessing the future line of action. However, in certain life-threatening conditions obtaining imaging studies can causes an unnecessary and potential lethal delay in treatment.

Role of bedside sonography in the assessment of patients with chest trauma in the emergency department of Suez Canal University Hospital

“…Between 20-46% of deaths in poly-traumatic patients are due to chest injury. 1,2 Pneumothorax is a common complication of blunt and stab chest trauma. 3 Rate of occurrence of tension pneumothorax is 10% while traumatic pneumothorax, iatrogenic pneumothorax and late pneumothorax occur in 33.6%, 18.1% and 12% traumatic population, respectively.…”

Management of pneumothorax with oxygen therapy: a case series

“…9 Supplemental oxygen is recommended as a treatment option in all types of pneumothoraces. 2,9 The rate of re-absorption of air in the pneumothorax is 1.25-1.8% of the Case Report volume of hemithorax every 24 hours. There is a four-fold increase in this rate of re-absorption of air with the administration of supplemental oxygen.…”

“…Treatment strategies include observation, oxygen therapy, needle aspiration or intercostal chest tube (ICT) insertion. 1 Oxygen therapy is useful in the treatment of traumatic 2 and spontaneous pneumothorax 3 where it is found to be safe, efficacious and associated with reduced length of hospital stay. Hospitalised cases of pneumothorax who are not subjected to needle aspiration and ICT drainage, due to any reason, may be managed with supplemental oxygen therapy administered at high concentrations.…”

Open pneumothorax: the spectrum and outcome of management based on Advanced Trauma Life Support recommendations

“…Open pneumothoraces (OPTX) refer to a specific subgroup of traumatic pneumothoraces that are commonly referred to as "sucking chest wounds" [2]. Typically a chest wall defect is present which directly communicates with the parietal pleura.…”