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2.1
Iatrogenic Pneumothorax
Pneumothorax Iatrogenic

Presentation

State-of-the-art scientific knowledge is presented at an appropriate level for the practicing clinician, and published management guidelines are included where relevant. [books.google.com]

We present the case of an iatrogenic pneumothorax during placement of the chest sensor lead between the intercostal muscles. Following clinical and radiological evaluation, surgery was continued and the patient was treated expectantly. [ncbi.nlm.nih.gov]

Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and D-dimer. Ann Intern Med. ‎ [books.google.de]

Entire Body System

  • Pain

    pain Pain that worsens over time Chest pain worse with or causing non - productive cough Sudden unexplained shortness of breath or difficulty breathing Points to Use With Caution Pneumothorax due to acupuncture is rare. [healthcmi.com]

    A pneumothorax is a type of lung injury that allows air to leak into the area between the lungs and the chest wall, which causes mild to severe chest pain and shortness of breath. [quality.nm.org]

    Adequate analgesia is important and often substantially improves breathlessness, which may be largely related to the pain of breathing. For information on analgesia, see acute pain in adults and acute pain in children. [quartz.tg.com.au]

    Chest pain : a pleuritic pain may give a sensation of breathlessness. Examples include pleurodynia and Bornholm disease. Pulmonary embolism may produce haemoptysis and a few rales over the affected area. [patient.info]

    Patients with pneumothorax present with sudden-onset dyspnea, ipsilateral chest pain, diminished breath sounds, and hyperresonant percussion on the affected side. [amboss.com]

Respiratoric

  • Aspiration

    BACKGROUND: Although manual aspiration is used for treating pneumothorax, the post-aspiration radiograph may not be a reliable indicator of whether the pleural leak remains. [ncbi.nlm.nih.gov]

    Thirteen percent of patients had aspiration of which three-quarters needed subsequent intervention. Symptoms or FEV1 did not predict need for intervention. [thorax.bmj.com]

    Catheter aspiration For catheter aspiration of a pneumothorax (sometimes termed thoracocentesis), see Box 9.9. [quartz.tg.com.au]

    Needle aspiration should not be repeated unless there were technical difficulties. Following failed needle aspiration, a small-bore ( [ 1 ]. [patient.info]

  • Pneumonia

    Thoracentesis appeared to be a high-risk procedure for patients who were admitted for secondary malignancies, pleurisy, or pneumonia, with AIP rates at 3.76%, 3.13%, and 2.28%, respectively. [ncbi.nlm.nih.gov]

    anaerobic pneumonia, staphylococcal pneumonia, AIDS with P carinii pneumonia, and Mycobacterium tuberculosis Malignancies: Sarcoma, lung cancer Pneumoconiosis: Silicoproteinosis, berylliosis, and bauxite pneumoconiosis Connective tissue diseases Wegener [razianesth.freeservers.com]

    ( J69.- ) emphysema (subcutaneous) resulting from a procedure ( T81.82 ) hypostatic pneumonia ( J18.2 ) pulmonary manifestations due to radiation ( J70.0- J70.1 ) Intraoperative and postprocedural complications and disorders of respiratory system, not [icd10data.com]

    A prediction rule to identify low-risk patients with community-acquired pneumonia. ‎ Seite 159 - Pulsiripunya C, Youngchaiyud P, Pushpakom R, et al. [books.google.de]

  • Pleural Effusion

    The efficacy of doxycycline as a pleural sclerosing agent in malignant pleural effusion: a prospective study. Respirology 1996;l:69-72. ‎ [books.google.de]

    Thoracocentesis (pleural aspiration) was performed on this patient with a pleural effusion. After invasive procedures such as this, a chest X-ray should be requested, specifically to check for a pneumothorax. [radiologymasterclass.co.uk]

    The efficacy of doxycycline as a pleural sclerosing agent in malignant pleural effusion: a prospective study. Respirology 1996;l:69-72. ‏ [books.google.com]

    PLEURAL EFFUSION Fluid in the pleural space is called pleural effusion. The fluid may be lymph (chylothorax), pus (empyema), blood (hemothorax), or non-specific serous fluid. [teleflex.com]

    Traumatic pneumothorax was associated with blunt chest trauma, pleural effusion, hemothorax, cranial trauma, fractured collarbone, upper and lower limb fracture, pelvic fracture, vertebral and spinal trauma, sternum fracture and abdominal trauma. [giornalechirurgia.it]

  • Dyspnea

    Patients with pneumothorax present with sudden-onset dyspnea, ipsilateral chest pain, diminished breath sounds, and hyperresonant percussion on the affected side. [amboss.com]

    Large volume pneumothoraces cause dyspnea, tachycardia, hypotension, and hypoxia. Clinical signs of tension pneumothorax include tracheal deviation, hyperresonance, and hypotension. [aneskey.com]

    Suspicion for pneumothorax should remain heightened in patients with chronic obstructive pulmonary disease (COPD) who develop dyspnea and unilateral chest pain. [razianesth.freeservers.com]

    Dyspnea and chest pain are the most common symptoms of pneumothorax. Decreased breath sounds and lack of movement on the affected side may also be observed. [teleflex.com]

    Clinical Presentation Ipsilateral pleuritic chest pain or acute dyspnea & tachycardia. Symptoms usually resolve within 24 hours, even if the pneumothorax remains untreated and does not resolve. [enotes.tripod.com]

  • Hyperresonance

    Patients with pneumothorax present with sudden-onset dyspnea, ipsilateral chest pain, diminished breath sounds, and hyperresonant percussion on the affected side. [amboss.com]

    Clinical signs of tension pneumothorax include tracheal deviation, hyperresonance, and hypotension. DIAGNOSIS AND DIFFERENTIAL Electrocardiographic changes, including ST changes and T-wave inversion, may be seen with pneumothorax. [aneskey.com]

    6,7 Signs and symptoms of iatrogenic pneumothorax include: ipsilateral chest pain that may radiate to neck, back, and shoulder hemodynamic instability tachycardia tachypnea dyspnea hypoxemia ipsilateral decreased or absent breath sounds ipsilateral hyperresonance [journals.lww.com]

    Physical exam findings for a pneumothorax are unequal breath sounds, hyperresonance with percussion over the chest wall, and decreased wall movement on the affected side of the chest. [cdemcurriculum.com]

    In a large pneumothorax, physical signs include absent breath sounds, tachypnoea, decreased chest wall movement, hyperresonance to percussion, decreased vocal resonance and tracheal deviation to the opposite side. [quartz.tg.com.au]

Cardiovascular

  • Chest Pain

    Onset of pneumothorax is marked by sudden sharp chest pain, shortness of breath and an unproductive cough. [healthcmi.com]

    A pneumothorax is a type of lung injury that allows air to leak into the area between the lungs and the chest wall, which causes mild to severe chest pain and shortness of breath. [quality.nm.org]

    Dyspnea and chest pain are the most common symptoms of pneumothorax. Decreased breath sounds and lack of movement on the affected side may also be observed. [teleflex.com]

    The most common symptoms include: Sharp, stabbing type chest pain that may spread to the shoulder and back Shortness of breath or trouble breathing Fast, shallow, breathing In more severe cases, symptoms can also include: Fast heartbeat Bluish tinge to [fairview.org]

    He states he started having left-sided chest pain and trouble breathing about 15 minutes earlier but thought it would get better on its own. You suspect that Mr. S may have an iatrogenic pneumothorax and immediately activate the rapid response team. [journals.lww.com]

  • Hypotension

    Large volume pneumothoraces cause dyspnea, tachycardia, hypotension, and hypoxia. Clinical signs of tension pneumothorax include tracheal deviation, hyperresonance, and hypotension. [aneskey.com]

    Vital signs frequently demonstrate tachycardia, tachypnea and, depending on the severity, hypoxia and hypotension. [cdemcurriculum.com]

    It can lead - often quite suddenly - to life-threatening hypotension and shock, making it a medical emergency (Light RW, 2016). [patientsafetyinstitute.ca]

    Should the pneumothorax progress to a tension pneumothorax, additional assessment findings may include jugular vein distension, profound tachycardia, profound tachypnea, absent breath sounds on the affected side, hypotension, cyanosis, significantly increased [journals.lww.com]

    The potential complications associated with Pneumothorax in Infants may include: Hypotension (a drop in blood pressure) Tension pneumothorax: Air build up in the lung puts pressure on the heart and on the other lung. [dovemed.com]

  • Tachycardia

    Vital signs frequently demonstrate tachycardia, tachypnea and, depending on the severity, hypoxia and hypotension. [cdemcurriculum.com]

    Should the pneumothorax progress to a tension pneumothorax, additional assessment findings may include jugular vein distension, profound tachycardia, profound tachypnea, absent breath sounds on the affected side, hypotension, cyanosis, significantly increased [journals.lww.com]

    Large volume pneumothoraces cause dyspnea, tachycardia, hypotension, and hypoxia. Clinical signs of tension pneumothorax include tracheal deviation, hyperresonance, and hypotension. [aneskey.com]

    Signs/symptoms of tension pneumothorax include: rapid, labored respirations; tachycardia; cyanosis; hypoxemia; and sudden chest pain that extends to the shoulders. [teleflex.com]

    Monitor was showing tachycardia but no pulse. The physician immediately recognized the wrong connection of nebulizer and removed it. The patient was given ventilation through ambu bag connected to endotracheal tube. [ijccm.org]

Workup

T Wave

  • T Wave Inversion

    DIAGNOSIS AND DIFFERENTIAL Electrocardiographic changes, including ST changes and T-wave inversion, may be seen with pneumothorax. The standard diagnostic modality, an upright poster-oanterior chest radiograph ( Fig. 34-1 ), is only 83% sensitive. [aneskey.com]

Pleura

  • Pleural Effusion

    The efficacy of doxycycline as a pleural sclerosing agent in malignant pleural effusion: a prospective study. Respirology 1996;l:69-72. ‎ [books.google.de]

    Thoracocentesis (pleural aspiration) was performed on this patient with a pleural effusion. After invasive procedures such as this, a chest X-ray should be requested, specifically to check for a pneumothorax. [radiologymasterclass.co.uk]

    The efficacy of doxycycline as a pleural sclerosing agent in malignant pleural effusion: a prospective study. Respirology 1996;l:69-72. ‏ [books.google.com]

    PLEURAL EFFUSION Fluid in the pleural space is called pleural effusion. The fluid may be lymph (chylothorax), pus (empyema), blood (hemothorax), or non-specific serous fluid. [teleflex.com]

    Traumatic pneumothorax was associated with blunt chest trauma, pleural effusion, hemothorax, cranial trauma, fractured collarbone, upper and lower limb fracture, pelvic fracture, vertebral and spinal trauma, sternum fracture and abdominal trauma. [giornalechirurgia.it]

Treatment

Most patients required treatment for 4-7 days; however, hospitalization was prolonged due to this treatment in only 8% of patients, presumably because of their underlying disease which required long hospitalization. [ncbi.nlm.nih.gov]

Iatrogenic means that is was caused by medical treatment, often as an incidental event during a procedure.. Most cases of iatrogenic pneumothorax are not serious and do not require any treatment. [quality.nm.org]

Escalante, MD, FACP Professor and Chair, Dept of General Internal Medicine,Ambulatory Treatment and Emergency CareThe University of Texas, M. D. Anderson Cancer CenterHouston, Texas Robert F. [books.google.com]

For example, ACC now funds this treatment in certain circumstances. Response Acupuncture is part of Traditional Chinese Medicine. It is used worldwide as an alternative medical therapy. [health.govt.nz]

Early diagnosis and treatment of this complication is recommended. Keeping an intracatheter, pigtail catheter, or Heimlich valve in the surgical facility for treatment of a possible tension pneumothorax is essential. [link.springer.com]

Prognosis

Prognosis Up to 50% of patients who suffer from a pneumothorax will have another or a recurring pneumothorax. However, there are no long-term complications after successful treatment. [physio-pedia.com]

Prognosis [ 1 ] While death from spontaneous pneumothorax is rare, rates of recurrence are high: 15.8% at one year for PSP and 31.2% at one year for SSP. [patient.info]

Instillation of a sclerosant through a chest tube may be used in certain circumstances (Good Consensus) based on patients’ contraindications to surgery, management preferences, and underlying poor patient prognosis (see below for sclerosant choice). [enotes.tripod.com]

Most studies of the prognosis and outcome of IP were retrospective and focused on a single category of IP. 9,11–17 The development of lung-protective strategies for ventilation and of new material, techniques, and recommendations for inserting central [anesthesiology.pubs.asahq.org]

Etiology

Further randomized control studies are warranted to evaluate the etiology of this finding. Published by Elsevier Inc. [ncbi.nlm.nih.gov]

Chapters in the clinical section are written in an accessible and uniform style, making extensive use of illustrative material and covering definition, incidence and epidemiology, etiology and pathogenesis, clinical presentation, investigations, treatments [books.google.com]

pneumothorax occurs as a complication of underlying lung disease Tension pneumothorax : life-threatening variant of pneumothorax characterized by progressively increasing pressures within the chest and cardiorespiratory compromise References: [1] Etiology [amboss.com]

Epidemiology

Chapters in the clinical section are written in an accessible and uniform style, making extensive use of illustrative material and covering definition, incidence and epidemiology, etiology and pathogenesis, clinical presentation, investigations, treatments [books.google.com]

Epidemiology Primary spontaneous pneumothorax Sex : ♂ > ♀ ( approx. 6:1 ) Peak incidence : 20–3 0 years Secondary spontaneous pneumothorax Sex : ♂ > ♀ ( approx. 3:1 ) Peak incidence : 60–65 years References: [1] Epidemiological data refers to the US, [amboss.com]

Epidemiology The incidence of primary spontaneous pneumothorax (PSP) is 24/100,000 a year in men and 9.9/100,000 a year in women in England and Wales [ 4 ]. [patient.info]

† Professor, Group of Epidemiology, Institut National de la Santé et de la Recherche Médicale (INSERM) U578, Grenoble, France, and Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard Teaching Hospital, Paris, France [anesthesiology.pubs.asahq.org]

In Stockholm, in one of the largest epidemiologic studies performed (reported by Bense et al), the annual incidence of PSP in 15,204 individuals was somewhat higher than in the Minnesota study: 18 per 100,000 men and 6 per 100,000 women. [razianesth.freeservers.com]

Pathophysiology

In the following review, we discuss pathophysiology, diagnosis, and expected outcomes. Surgeons placing hypoglossal nerve stimulators should be aware of complications and prepared to manage a pneumothorax. [ncbi.nlm.nih.gov]

Building on the many strengths of the highly respected first edition, the book features a detailed yet lucid basic science section to support understanding of the physiological and pathophysiological mechanisms that underlie diseases of the pleura. [books.google.com]

PATHOPHYSIOLOGY Pneumothorax likely occurs after rupture of a sub-pleural bulla allows air to enter the potential space between the parietal and visceral pleura, leading to partial lung collapse. [aneskey.com]

Gioffrè Florio The aim of this study was to collect information on the incidence, pathophysiology, treatment and mortality of pneumothorax in the Emergency Room. [giornalechirurgia.it]

References: [1] Pathophysiology Increased intrapleural pressure → alveolar collapse → decreased V/Q ratio and increased right-to-left shunting Spontaneous pneumothora x : rupture of blebs and bullae → air moves into pleural space with increasing positive [amboss.com]

Prevention

In the new issue of SonoSite news, it discusses this and how the tool that could prevent pneumothorax from occurring, if used during your procedures, is the exact tool that is best to diagnose at bedside. How ironic is that?! [sonospot.wordpress.com]

[…] catheterization procedure, the clinician accidentally causes a pneumothorax, Medicare will no longer reimburse the hospital for the extra costs of a resulting pneumothorax (collapsed lung) complication.Medicare’s inclusion of iatrogenic pneumothorax as a preventable [sonosite.com]

In this case, we effectively utilized ultrasound and avoided preventive chest tube placement and the associated complications. [dovepress.com]

Prevention of Pneumothorax Recurrence The panel had divided opinion on the question: "Should patients with their first primary spontaneous pneumothorax be offered an intervention to prevent recurrence?" [enotes.tripod.com]

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