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The Annals of Thoracic Surgery Aug 2022Our objective was to report the incidence, management, and outcomes of patients who developed a secondary pneumothorax while admitted for coronavirus disease 2019...
BACKGROUND
Our objective was to report the incidence, management, and outcomes of patients who developed a secondary pneumothorax while admitted for coronavirus disease 2019 (COVID-19).
METHODS
A single-institution, retrospective review of patients admitted for COVID-19 with a diagnosis of pneumothorax between March 1, 2020, and April 30, 2020, was performed. The primary assessment was the incidence of pneumothorax. Secondarily, we analyzed clinical outcomes of patients requiring tube thoracostomy, including those requiring operative intervention.
RESULTS
From March 1, 2020, to April 30, 2020, 118 of 1595 patients (7.4%) admitted for COVID-19 developed a pneumothorax. Of these, 92 (5.8%) required tube thoracostomy drainage for a median of 12 days (interquartile range 5-25 days). The majority of patients (95 of 118, 80.5%) were on mechanical ventilation at the time of pneumothorax, 17 (14.4%) were iatrogenic, and 25 patients (21.2%) demonstrated tension physiology. Placement of a large-bore chest tube (20 F or greater) was associated with fewer tube-related complications than a small-bore tube (14 F or less) (14 vs 26 events, P = .011). Six patients with pneumothorax (5.1%) required operative management for a persistent alveolar-pleural fistula. In patients with pneumothorax, median hospital stay was 36 days (interquartile range 20-63 days) and in-hospital mortality was significantly higher than for those without pneumothorax (58% vs 13%, P < .001).
CONCLUSIONS
The incidence of secondary pneumothorax in patients admitted for COVID-19 is 7.4%, most commonly occurring in patients requiring mechanical ventilation, and is associated with an in-hospital mortality rate of 58%. Placement of large-bore chest tubes is associated with fewer complications than small-bore tubes.
Topics: COVID-19; Chest Tubes; Drainage; Humans; Incidence; Pneumothorax; Retrospective Studies; Thoracostomy
PubMed: 34481799
DOI: 10.1016/j.athoracsur.2021.07.097 -
Canadian Family Physician Medecin de... Oct 2020A 15-year-old boy in my practice returned for follow-up after having a spontaneous pneumothorax. He spent 6 hours in the emergency department and received oxygen. How...
A 15-year-old boy in my practice returned for follow-up after having a spontaneous pneumothorax. He spent 6 hours in the emergency department and received oxygen. How common is this condition, and what needs to be considered regarding management and recurrence? Primary spontaneous pneumothorax-penetration of air in the pleural space between the lung and the chest wall-in children is common, and the incidence seems to be on the rise. Emphysematous bleb, asthma, and tobacco use were the most common findings associated with the condition, and in young children pneumothorax might be associated with underlying congenital anomalies. Auscultation and observation of the chest with imaging are used to diagnose the condition, and recurrence in adolescents is common. Treatment includes supportive therapy (mostly rest and oxygen) for small pneumothorax or placing a chest tube or definitive surgical treatment for larger pneumothorax.
Topics: Adolescent; Chest Tubes; Child; Child, Preschool; Emergency Service, Hospital; Humans; Male; Pneumothorax; Recurrence
PubMed: 33077450
DOI: No ID Found -
Journal of Intensive Care Medicine Aug 2022Pneumothorax (PTX) and pneumomediastinum (PM), collectively termed here "air leak", are now well described complications of severe COVID-19 pneumonia across several case... (Observational Study)
Observational Study
BACKGROUND
Pneumothorax (PTX) and pneumomediastinum (PM), collectively termed here "air leak", are now well described complications of severe COVID-19 pneumonia across several case series. The incidence is thought to be approximately 1% but is not definitively known.
OBJECTIVES
To report the incidence and describe the demographic features, risk factors and outcomes of patients with air leak as a complication of COVID-19.
METHODS
A retrospective observational study on all adult patients with COVID-19 admitted to Watford General Hospital, West Hertfordshire NHS Trust between March 1st 2020 and Feb 28 2021. Patients with air leak were identified after reviewing both chest radiographs (CXRs) and axial imaging (CT Thorax) with confirmatory radiology reports inclusive of the terms PTX and/or PM.
RESULTS
Air leak occurred with an incidence of 0.56%. Patients with air leak were younger and had evidence of more severe disease at presentation, including a higher median CRP and number of abnormal zones affected on chest radiograph. Asthma was a significant risk factor in the development of air leak (OR 13.4 [4.7-36.4]), both spontaneously and following positive pressure ventilation. CPAP and IMV were also associated with a greater than six fold increase in the risk of air leak (OR 6.4 [2.5-16.6] and 9.8 [3.7-27.8] respectively). PTX, with or without PM, in the context of COVID-19 pneumonia was almost universally fatal whereas those with alone PM had a lower risk of death.
CONCLUSION
Despite the global vaccination programme, patients continue to develop severe COVID-19 disease and may require respiratory support. This study demonstrates the importance of identifying that deterioration in such patients may be resultant from PTX or PM, particularly in asthmatics and those managed with positive pressure ventilation.
Topics: Adult; COVID-19; Humans; Incidence; Mediastinal Emphysema; Pneumothorax; Risk Factors
PubMed: 35360973
DOI: 10.1177/08850666221091441 -
European Review For Medical and... Nov 2022The effect of pulmonary complications of COVID-19, such as pneumothorax, pneumomediastinum, and subcutaneous emphysema, is still unclear. This study aimed at...
OBJECTIVE
The effect of pulmonary complications of COVID-19, such as pneumothorax, pneumomediastinum, and subcutaneous emphysema, is still unclear. This study aimed at investigating the relationship between COVID-19 and spontaneous pneumothorax.
PATIENTS AND METHODS
This study was conducted as a single-center retrospective study. Groups were assigned as study and control groups. The study group (n=120) included patients who were followed up in ICU and developed pneumothorax during their follow-up. The control group (n=120) included patients who did not develop a pneumothorax in ICU and who had been randomly selected using hospital records. Demographic findings, laboratory parameters, radiological findings, clinical management, patients' follow-up patterns, and survival status of the patients were recorded.
RESULTS
There was a significant relationship between gender, outcome, last hospitalization, general condition, first follow-up, intubation, uptake tomography, uptake rate, CO-RADS, and involvement variables between groups (p<0.05). In the survival analysis performed in the control and study groups, a significant difference was obtained between the averages of the two groups (LogRank=3.944, p<0.05). Intubation and mortality rates of the patients who developed pneumothorax during the patient follow-ups were significantly higher than the control group.
CONCLUSIONS
We found that patients diagnosed with COVID-19 who developed pneumothorax during intensive care follow-up had a higher hospital stay and intubation rate. The pneumothorax rate was also higher in follow-up methods such as noninvasive/HFO providing PEEP to the patients. The data in our study may help reducing mortality by shedding light on the early prevention and recognition of pneumothorax in critically ill patients diagnosed with COVID-19.
Topics: Humans; Pneumothorax; Retrospective Studies; COVID-19; Mediastinal Emphysema; Length of Stay
PubMed: 36394764
DOI: 10.26355/eurrev_202211_30168 -
Medicina (Kaunas, Lithuania) Jul 2022Background and Objectives: Pneumothorax implies the presence of air in the pleural space between the visceral and parietal pleura. The aim of this study was to...
Background and Objectives: Pneumothorax implies the presence of air in the pleural space between the visceral and parietal pleura. The aim of this study was to investigate the incidence, clinical characteristics, risk factors, therapy and perinatal outcome in neonates with pneumothorax in a tertiary care center. Materials and Methods: A retrospective study based on a five-year data sample of neonates with pneumothorax was conducted in a Maternity Hospital with a tertiary NICU from 2015 to 2020. We included all neonates with pneumothorax born in our hospital and compared demographic characteristics, perinatal risk factors, anthropometric parameters, comorbidities, clinical course and method of chest drainage between term (≥37 GW) and preterm (<37 GW) neonates. Results: The study included 74 newborns with pneumothorax, of which 67.6% were male and 32.5% were female. The majority of women (59.5%) had no complications during pregnancy. Delivery was mainly performed via CS (68.9%). Delivery occurred on average in 34.62 ± 4.03 GW. Significantly more (p = 0.001) children with pneumothorax were born prematurely (n = 53; 71.6%) than at term (n = 21; 28.4%). Most of the neonates had to be treated with ATD (63.5%) and nCPAP (39.2%), but less often they were treated with surfactant (40.5%) and corticosteroids (35.1%). O2 therapy lasted an average of 8.89 ± 4.57 days. Significantly more (p = 0.001) neonates with pneumothorax had additional complications, pneumonia, sepsis, convulsions and intraventricular hemorrhage (68.9%). However, most children had a good outcome (83.8%) and were discharged from the clinic. Fatal outcomes occurred in six cases, while another six neonates had to be transferred to referral neonatal centers for further treatment and care. Conclusion: Significantly more children with pneumothorax were born prematurely than at term. With adequate therapy, even premature newborns can successfully recover from pneumothorax.
Topics: Child; Female; Humans; Incidence; Infant, Newborn; Male; Pneumothorax; Pregnancy; Pulmonary Surfactants; Retrospective Studies; Risk Factors
PubMed: 35888683
DOI: 10.3390/medicina58070965 -
Aesthetic Surgery Journal Jun 2020Pneumothorax is a rare complication of liposuction resulting from injury to the lung parenchyma.
BACKGROUND
Pneumothorax is a rare complication of liposuction resulting from injury to the lung parenchyma.
OBJECTIVES
This study aimed to determine the incidence of pneumothorax complicating liposuction, describe an archetypal presentation, identify risk factors, and propose options for risk reduction.
METHODS
In a retrospective chart review, liposuction procedures performed over a 16-year period by 8 surgeons in 1 practice were screened for pneumothorax. Cases featuring pneumothorax were analyzed to ascertain risk factors, presentation, and pathogenesis.
RESULTS
Among the 16,215 liposuction procedures performed during the study period, 7 pneumothoraxes were identified (0.0432%). Six (85.7%) were female. Three (42.9%) had previous liposuction. Six cases (85.7%) included liposuction of the axillary region. All cases featured depression of intra/postoperative oxygen saturations as the initial sign. Three (42.9%) were identified intraoperatively. All patients were transferred to a hospital for imaging. Five (71.4%) underwent chest tube placement. Two (28.6%) were treated with observation alone. Pneumothoraxes were left-sided in 4 cases (57.1%), and right-sided in 3 cases (42.9%). In early cases, 1.5-mm infiltration cannulas were used; in 2016 cannula size was changed to 3-4 mm for infiltration and 4-5 mm for liposuction.
CONCLUSIONS
Possible risk factors for pneumothorax include liposuction of the axilla, use of flexible infiltration cannulas, and scarring from previous liposuction. We recommend including pneumothorax as a potential complication during informed consent, performing infiltration with a stiff >3.5-mm cannula, minimizing positive-pressure ventilation, emphasized awareness of cannula tip location in all patients but particularly in patients with previous liposuction or scar tissue, and increased caution when operating in the axillary area.
Topics: Axilla; Female; Humans; Lipectomy; Pneumothorax; Postoperative Period; Retrospective Studies
PubMed: 32004368
DOI: 10.1093/asj/sjaa029 -
Current Opinion in Pulmonary Medicine Jul 2017Diffuse cystic lung diseases (DCLDs) are a heterogeneous group of disorders with varying pathophysiologic mechanisms that are characterized by the presence of air-filled... (Review)
Review
PURPOSE OF REVIEW
Diffuse cystic lung diseases (DCLDs) are a heterogeneous group of disorders with varying pathophysiologic mechanisms that are characterized by the presence of air-filled lung cysts. These cysts are prone to rupture, leading to the development of recurrent spontaneous pneumothoraces. In this article, we review the epidemiology, clinical features, and management DCLD-associated spontaneous pneumothorax, with a focus on lymphangioleiomyomatosis, Birt-Hogg-Dubé syndrome, and pulmonary Langerhans cell histiocytosis.
RECENT FINDINGS
DCLDs are responsible for approximately 10% of apparent primary spontaneous pneumothoraces. Computed tomography screening for DCLDs (Birt-Hogg-Dubé syndrome, lymphangioleiomyomatosis, and pulmonary Langerhans cell histiocytosis) following the first spontaneous pneumothorax has recently been shown to be cost-effective and can help facilitate early diagnosis of the underlying disorders. Patients with DCLD-associated spontaneous pneumothorax have a very high rate of recurrence, and thus pleurodesis should be considered following the first episode of spontaneous pneumothorax in these patients, rather than waiting for a recurrent episode. Prior pleurodesis is not a contraindication to future lung transplant.
SUMMARY
Although DCLDs are uncommon, spontaneous pneumothorax is often the sentinel event that provides an opportunity for diagnosis. By understanding the burden and implications of pneumothoraces in DCLDs, clinicians can facilitate early diagnosis and appropriate management of the underlying disorders.
Topics: Humans; Lung Diseases; Pneumothorax; Tomography, X-Ray Computed
PubMed: 28590337
DOI: 10.1097/MCP.0000000000000391 -
The European Respiratory Journal Nov 2020Thoracentesis using suction is perceived to have increased risk of complications, including pneumothorax and re-expansion pulmonary oedema (REPO). Current guidelines...
BACKGROUND
Thoracentesis using suction is perceived to have increased risk of complications, including pneumothorax and re-expansion pulmonary oedema (REPO). Current guidelines recommend limiting drainage to 1.5 L to avoid REPO. Our purpose was to examine the incidence of complications with symptom-limited drainage of pleural fluid using suction and identify risk factors for REPO.
METHODS
A retrospective cohort study of all adult patients who underwent symptom-limited thoracentesis using suction at our institution between January 1, 2004 and August 31, 2018 was performed, and a total of 10 344 thoracenteses were included.
RESULTS
Pleural fluid ≥1.5 L was removed in 19% of the procedures. Thoracentesis was stopped due to chest discomfort (39%), complete drainage of fluid (37%) and persistent cough (13%). Pneumothorax based on chest radiography was detected in 3.98%, but only 0.28% required intervention. The incidence of REPO was 0.08%. The incidence of REPO increased with Eastern Cooperative Oncology Group performance status (ECOG PS) ≥3 compounded with ≥1.5 L (0.04-0.54%; 95% CI 0.13-2.06 L). Thoracentesis in those with ipsilateral mediastinal shift did not increase complications, but less fluid was removed (p<0.01).
CONCLUSIONS
Symptom-limited thoracentesis using suction is safe even with large volumes. Pneumothorax requiring intervention and REPO are both rare. There were no increased procedural complications in those with ipsilateral mediastinal shift. REPO increased with poor ECOG PS and drainage ≥1.5 L. Symptom-limited drainage using suction without pleural manometry is safe.
Topics: Adult; Drainage; Humans; Pleural Effusion; Pneumothorax; Retrospective Studies; Suction; Thoracentesis
PubMed: 32499336
DOI: 10.1183/13993003.02356-2019 -
Molecular Genetics & Genomic Medicine May 2018Birt-Hogg-Dubé syndrome (BHD) is an autosomal dominantly inherited cancer predisposition syndrome associated with an increased risk of spontaneous pneumothorax (SP) and... (Review)
Review
BACKGROUND
Birt-Hogg-Dubé syndrome (BHD) is an autosomal dominantly inherited cancer predisposition syndrome associated with an increased risk of spontaneous pneumothorax (SP) and renal cell carcinoma in the adult population. Recent studies suggest that BHD accounts for up to 10% of all SP in adults and BHD in children with SP have been reported.
METHODS
To explore to what extent BHD is the cause of childhood pneumothorax, we studied a Danish BHD cohort consisting of 109 cases from 22 families. Clinical data was gathered by review of medical records. A systematic literature search concerning childhood and adolescence pneumothorax in BHD was performed and identified publications reviewed.
RESULTS
In our cohort, three of 109 BHD cases experienced childhood pneumothorax, corresponding to a prevalence of 3%. Reviewing the literature, data regarding more than 800 BHD cases were covered. Only seven previously published cases of childhood pneumothorax in BHD were identified.
CONCLUSION
Our findings suggest that BHD is likely the cause of a larger subset of childhood pneumothoraces than hitherto recognized. Awareness of BHD as a cause of childhood pneumothorax needs to be raised to provide patients and relatives with the possibility of specialized management of SP and regular renal cancer surveillance.
Topics: Adolescent; Adult; Birt-Hogg-Dube Syndrome; Carcinoma, Renal Cell; Child; Cohort Studies; Cysts; Female; Humans; Kidney Neoplasms; Male; Middle Aged; Netherlands; Pneumothorax
PubMed: 29439288
DOI: 10.1002/mgg3.373 -
The Journal of the American Osteopathic... Jan 2020
Topics: Adult; Chest Tubes; Female; Humans; Pneumothorax; Postoperative Complications; Pulmonary Edema; Thoracostomy
PubMed: 31904775
DOI: 10.7556/jaoa.2020.011