-
Deutsches Arzteblatt International Nov 2017Few reliable data are available on the epidemiology and treatment of spontaneous pneumothorax. We studied the sex and age distribution, frequency of hospitalization,...
BACKGROUND
Few reliable data are available on the epidemiology and treatment of spontaneous pneumothorax. We studied the sex and age distribution, frequency of hospitalization, mortality, and conservative versus surgical care of this condition in Germany in order to draw well-founded conclusions about its in-hospital diagnosis and treatment.
METHODS
Data from all patients aged 10 or older who were hospitalized in the period 2011-2015 with a main discharge diagnosis of pneumothorax of neither traumatic nor iatrogenic origin were retrieved from the German Federal Statistical Office. Because of their source, all data were based on case numbers rather than patient numbers.
RESULTS
During the period of the study, there were 52 738 admissions with the main diagnosis of spontaneous pneumothorax, corresponding to an annual frequency of hospitalization of 14.3 per 100 000 persons per year (95% confidence interval, 14.0 to 14.5). Men were more frequently affected than women. The lethality and in-hospital mortality of this condition (≤ 0.08% and ≤ 0.3%, respectively) were low among persons aged 15 to 45, but markedly higher in persons over age 90 (9.4% and 15.9%, respectively). The frequency of accompanying pulmonary diagnoses also rose with age. Computerized tomography (CT) was performed in 38.9-54.6% of hospitalizations, depending on age. Monitoring on an intensive care unit was carried out in 36% of cases. More than one-quarter of cases involved surgical treatment.
CONCLUSION
The danger to life and the likelihood of an accompanying pulmonary diagnosis are both low up to age 45. Treatment on an intensive care unit and computerized tomography of the chest should be performed only for strict indications in patients under age 45. The pathophysiological basis of the differing patterns of illness depending on age and sex requires further investigation.
Topics: Adolescent; Adult; Age Distribution; Aged; Child; Female; Germany; Hospitalization; Humans; Male; Middle Aged; Pneumothorax; Young Adult
PubMed: 29169430
DOI: 10.3238/arztebl.2017.0739 -
Seminars in Respiratory and Critical... Aug 2023For decades, there has been scanty evidence, most of which is of poor quality, to guide clinicians in the assessment and management of pneumothorax. A recent surge in... (Review)
Review
For decades, there has been scanty evidence, most of which is of poor quality, to guide clinicians in the assessment and management of pneumothorax. A recent surge in pneumothorax research has begun to address controversies surrounding the topic and change the face of pneumothorax management. In this article, we review controversies concerning the etiology, pathogenesis, and classification of pneumothorax, and discuss recent advances in its management, including conservative and ambulatory management. We review the evidence base for the challenges of managing pneumothorax, including persistent air leak, and suggest new directions for future research that can help provide patient-centered, evidence-based management for this challenging cohort of patients.
Topics: Humans; Pneumothorax
PubMed: 37321247
DOI: 10.1055/s-0043-1769615 -
Clinical Medicine (London, England) Jul 2022
Topics: COVID-19; Humans; Mediastinal Emphysema; Pneumothorax; SARS-CoV-2; Tomography, X-Ray Computed
PubMed: 36220238
DOI: 10.7861/clinmed.22-4-s51 -
BMJ Case Reports Mar 2021
Topics: Empyema; Empyema, Pleural; Humans; Pneumothorax
PubMed: 33766977
DOI: 10.1136/bcr-2021-242197 -
BMJ Case Reports Jun 2019Acupuncture is a well-known form of complementary medicine that is increasingly being used worldwide. Despite being rare, pneumothorax is the most common serious...
Acupuncture is a well-known form of complementary medicine that is increasingly being used worldwide. Despite being rare, pneumothorax is the most common serious complication described in acupuncture. A 79-year-old woman was admitted to the emergency department with a pneumothorax. Two days before, she had undergone an acupuncture treatment for chronic back pain. She felt a sharp right shoulder pain as needles were inserted in the interscapular area. As the pain did not resolve, she consulted her general practitioner and had a chest radiography done, revealing a right-sided pneumothorax. At the hospital, a right chest tube was inserted with relief of the symptoms and lung expansion. The chest tube was removed on the second day of admission, and she was discharged on the third day. Both acupuncturists and clinicians need to be aware of the possibility of adverse events following acupuncture, especially in those who develop symptoms.
Topics: Acupuncture Therapy; Aged; Female; Humans; Pneumothorax
PubMed: 31189543
DOI: 10.1136/bcr-2018-228770 -
Medicine Jan 2024Thoracentesis is performed by 4 methods: gravity, manual aspiration, vacuum-bottle suction, and wall suction. This literature review investigates the safety of these... (Review)
Review
Thoracentesis is performed by 4 methods: gravity, manual aspiration, vacuum-bottle suction, and wall suction. This literature review investigates the safety of these techniques and determines if there is significant difference in complication rates. A comprehensive literature search revealed 6 articles studying thoracentesis techniques and their complication rates, reviewing 20,815 thoracenteses: 80 (0.4%) by gravity, 9431 (45.3%) by manual aspiration, 3498 (16.8%) by vacuum-bottle suction, 7580 (36.4%) by wall suction and 226 (1.1%) unspecified. Of the 6 studies, 2 were smaller with 100 and 140 patients respectively. Overall, there was a 4.4% complication rate including hemothoraces, pneumothoraces, re-expansion pulmonary edema (REPE), chest discomfort, bleeding at the site, pain, and vasovagal episodes. The pneumothorax and REPE rate was 2.5%. Sub-analyzed by each method, there was a 47.5% (38/80) complication rate in the gravity group, 1.2% (115/9431) in the manual aspiration group including 0.7% pneumothorax or REPE, 8% (285/3498) in the vacuum-bottle group including 3.7% pneumothorax or REPE, 4% (309/7580) in the wall suction group all of which were either pneumothorax or REPE, and 73% (166/226) in the unspecified group most of which were vasovagal episodes. Procedure duration was less in the suction groups versus gravity drainage. The 2 smaller studies indicated that in the vacuum groups, early procedure termination rate from respiratory failure was significantly higher than non-vacuum techniques. Significant complication rate from thoracentesis by any technique is low. Suction drainage was noted to have a lower procedure time. Symptom-limited thoracentesis is safe using vacuum or wall suction even with large volumes drained. Other factors such as procedure duration, quantity of fluid removed, number of needle passes, patients' BMI, and operator technique may have more of an impact on complication rate than drainage modality. All suction modalities of drainage seem to be safe. Operator technique, attention to symptom development, amount of fluid removed, and intrapleural pressure changes may be important in predicting complication development, and therefore, may be useful in choosing which technique to employ. Specific drainage modes and their complications need to be further studied.
Topics: Humans; Thoracentesis; Pneumothorax; Thoracic Surgical Procedures; Drainage; Suction; Pulmonary Edema; Respiratory Aspiration
PubMed: 38181250
DOI: 10.1097/MD.0000000000036850 -
Tidsskrift For Den Norske Laegeforening... Apr 2024Pneumothorax following shoulder arthroscopy, although rare, is documented in over 30 PubMed case reports as occurring during or within 10 hours post-procedure.
BACKGROUND
Pneumothorax following shoulder arthroscopy, although rare, is documented in over 30 PubMed case reports as occurring during or within 10 hours post-procedure.
CASE PRESENTATION
A fit septuagenarian underwent a two-hour arthroscopic rotator cuff repair with IV anaesthesia and laryngeal mask airway, without a nerve block. With one hour remaining of the operation, the patient had desaturation and hypotension. Lung sliding was absent on ultrasound and x-ray confirmed left-sided tension pneumothorax. Successful thoracic drain insertion and lung re-expansion facilitated his recovery, allowing discharge after 24 hours and symptom-free status at 6 months.
INTERPRETATION
This case highlights pneumothorax as an uncommon yet possible post-arthroscopic event. The speculated aetiology is the surgical procedure, where pump-induced pressure fluctuations may displace air into surrounding tissue. Instances of pneumomediastinum and subcutaneous emphysema without pneumothorax suggest arthroscopic origin of air. Prompt perioperative ultrasound can aid in detecting such critical complications.
Topics: Humans; Pneumothorax; Male; Arthroscopy; Middle Aged; Rotator Cuff Injuries
PubMed: 38651717
DOI: 10.4045/tidsskr.23.0542 -
Experimental and Clinical... Nov 2015The Spanish congress of the European association of pulmonologists and thoracic surgeons, held in 2009, confirmed the international classification of spontaneous...
The Spanish congress of the European association of pulmonologists and thoracic surgeons, held in 2009, confirmed the international classification of spontaneous pneumothorax in which catamenial (menstrual) pneumothorax was identified. Different from usual pneumothorax, its reason is not because of bleb disease in the lungs, but rather, caused by menstrual cycle in women. The cause was partly studied and explained by several theories. By the first of them, congenital defects (holes, fenestrations) in the diaphragm allow air to get into pleural space because of increased permeability of the fallopian tubes during menstruation. The second hypothesis, the same mechanism is considered, but it has been supposed that a hole in the diaphragm can be caused by endometriosis. The third theory, endometriosis of a pulmonary parenchyma can create leak of air during menstruation. The fourth theory, significance is attached to production of F2 prostaglandin, which is a powerful broncho- and vasoconstriction agent, causing ruptures of alveoli in women in the period of the woman's menstrual cycle. Two groups of patients were identified: with a defect in the diaphragm and without. Existence of such defects is described in 50% of cases. Having a wide clinical experience in the field of thoracic surgery, we, for the first time in practice, diagnosed catamenial pneumothorax in patients with the recurrence course of the disease.
Topics: Adult; Female; Humans; Menstrual Cycle; Pleurodesis; Pneumothorax; Predictive Value of Tests; Radiography; Recurrence; Talc; Thoracotomy; Treatment Outcome; Video-Assisted Surgery
PubMed: 26640936
DOI: 10.6002/ect.tdtd2015.P77 -
Respiratory Medicine Jan 2021The outpatient management of primary spontaneous pneumothorax (PSP) is still debated. The risk of a tension pneumothorax is used to justify active treatment like... (Review)
Review
The outpatient management of primary spontaneous pneumothorax (PSP) is still debated. The risk of a tension pneumothorax is used to justify active treatment like chest-tube drainage, although outpatient management can reduce both the time in hospital and the cost of treatment. It is also likely to be the patient's choice. This report is a reappraisal of the situations for which outpatient management, by monitoring alone, or using minimally invasive techniques, can be considered.
Topics: Ambulatory Care; Biopsy, Fine-Needle; Chest Tubes; Conservative Treatment; Cost Savings; Drainage; Humans; Monitoring, Physiologic; Outpatients; Patient Preference; Pneumothorax; Risk Assessment; Treatment Outcome
PubMed: 33248364
DOI: 10.1016/j.rmed.2020.106240 -
The Journal of International Medical... Dec 2020Pneumothorax after neurosurgical procedures is very rare and incompletely understood. This study was performed to explore the clinical characteristics and pathogenesis...
OBJECTIVE
Pneumothorax after neurosurgical procedures is very rare and incompletely understood. This study was performed to explore the clinical characteristics and pathogenesis of pneumothorax after neurosurgery.
METHODS
We retrospectively evaluated patients admitted from December 2016 to April 2019 for treatment of spontaneous intracranial hemorrhage. The inclusion criteria were neurosurgical procedures (open surgeries or endovascular intervention) performed under general anesthesia, no performance of central venous puncture during surgery, and occurrence of pneumothorax immediately after the neurosurgical procedure.
RESULTS
Eight patients developed pneumothorax after neurosurgical procedures for spontaneous intracranial hemorrhage under general anesthesia. Of the eight patients, seven had aneurysmal subarachnoid hemorrhage and one had left temporal-parietal hemorrhage. The lung injury prediction score (LIPS) was 3, 4, 5, 6, and 9.5 in three, one, two, one, and one patient, respectively. During the operation, volume-controlled ventilation (tidal volume, 8-10 mL/kg) was selected for all patients.
CONCLUSIONS
Neurogenic pulmonary edema, inappropriate mechanical ventilation, and stimulation by endotracheal intubation might conjointly contribute to postoperative pneumothorax. To avoid this rare entity, mechanical ventilation with a low tidal volume or low pressure during general anesthesia should be adopted for patients with hemorrhagic cerebrovascular diseases involving the temporal lobe and a LIPS of >3.
Topics: Adult; Female; Humans; Male; Middle Aged; Neurosurgical Procedures; Pneumothorax; Respiration, Artificial; Retrospective Studies; Tidal Volume
PubMed: 33290119
DOI: 10.1177/0300060520976496