The OPTICC trial: a multi-institutional study of occult pneumothoraces in critical care

Prevalence of large and occult pneumothoraces in patients with severe blunt trauma upon hospital admission: experience of 526 cases in a French level 1 trauma center

“…This absence of major event in our population is probably due to the prophylactic strategy of drainage in our center in case of large PTX on CT scan or when clinical signs are present. Mechanical ventilation has been reported to be associated with progression of PTXs in 25% to 30% of cases, with potentially severe clinical consequences [8,26,27]. Based on these findings, many experts have warned about the risk of incurring a tension PTX when applying mechanical ventilation in the presence of a PTX [19].…”

Management of pediatric occult pneumothorax in blunt trauma: a subgroup analysis of the American Association for the Surgery of Trauma multicenter prospective observational study

“…OPTX are identified in 2% to 15% of patients undergoing CT scan [14][15][16]. Controversy surrounding management has been reported, especially relating to confounding factors such as presence of rib fractures, risk of PPV, and the unknown rate of progression of PTX size [3,5,9,10].…”

“…The safety of managing OPTX without tube thoracostomy has been suggested, but no study has been large enough to definitely demonstrate safety of observation alone in the pediatric population [4][5][6]. Moreover, the confounding factors of positive pressure ventilation, rib fractures, or bilaterality on safe observation of OPTX has lead to variability in clinical practice [2,[7][8][9][10].…”

Opening Pandora’s box: the potential benefit of the expanded FAST exam is partially confounded by the unknowns regarding the significance of the occult pneumothorax

“…Decreased airway pressures and tidal volumes became routine in the critically ill, wherein ventilatory management stressed careful attention to controlling peak and mean airway pressures, and limiting pressures below those considered routine previously [67][68][69]. To further address this clinical question, the Canadian Trauma Trials Collaborative of the Trauma Association of Canada has initiated a multi-center prospective randomized trial of treating or observing selected mechanically ventilated patients with OPTXs [70].…”