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Respiratory Research Feb 2022Spontaneous pneumothorax is a common pathology but optimal initial treatment regime is not well defined. Treatment options including conservative management, needle...
BACKGROUND AND OBJECTIVE
Spontaneous pneumothorax is a common pathology but optimal initial treatment regime is not well defined. Treatment options including conservative management, needle aspiration (NA) or insertion of a small-bore chest drain. Recent large randomised controlled trials may change the treatment paradigm: comparing conservative and ambulatory management to standard care, but current guidelines need to be updated. The aim of this study was to assess the current "state of play" in the management of pneumothorax in the UK.
METHODS
Physicians and respiratory healthcare staff were invited to complete an online survey on the initial and subsequent management of pneumothorax.
RESULTS
This study is the first survey of pneumothorax practice across the UK, which highlights variation in practice: 50% would manage a large primary pneumothorax with minimal symptoms conservatively, compared to only 3% if there were significant symptoms; 64% use suction if the pneumothorax had not resolved after > 2 days, 15% always clamp the chest drain prior to removal; whereas 30% never do. NICE guidance recommends the use of digital suction but this has not translated into widespread usage: only 23% use digital suction to check for resolution of air leak).
CONCLUSION
Whilst there has always been allowance for individual clinician preference in guidelines, there needs to be consensus on the optimum management strategy. The challenge the new guidelines face is to design a simple and pragmatic approach, using this new evidence base.
Topics: Chest Tubes; Drainage; Humans; Incidence; Pneumothorax; United Kingdom
PubMed: 35130917
DOI: 10.1186/s12931-022-01943-9 -
Drug Discoveries & Therapeutics 2021COVID-19 is associated with rarer extra-parenchymal manifestations, namely pneumothorax (PTX) and pneumomediastinum (PM) leading to complications and increased... (Observational Study)
Observational Study
COVID-19 is associated with rarer extra-parenchymal manifestations, namely pneumothorax (PTX) and pneumomediastinum (PM) leading to complications and increased mortality. The study aims to describe the prevalence, risk factors for mortality, radiological characteristics and outcome of PTX/PM in patients admitted with COVID-19. This was a retrospective, single-centre, observational study in patients with confirmed COVID-19 presenting with non-iatrogenic PTX/PM from April 2020 to May 2021. Details pertaining to demographics, presentation, radiological characteristics, management and outcome were collected. Cases were classified into spontaneous and barotraumatic PTX/PM and a between-group comparison was performed using Chi-square and t-test. A total of 45 cases (mean age: 53.2 years, 82% males) out of 8,294 confirmed COVID-19 patients developed PTX/PM, the calculated incidence being 0.54%. 29 cases had spontaneous PTX/PM and the remaining 17 cases were attributed to barotrauma. The most common comorbidities were diabetes-mellitus (65.3%) and hypertension (42.3%). The majority of the cases had large PTX (62.1%) with tension in 8 cases (27.5%). There were predominant right-sided pneumothoraces and five were diagnosed with bronchopleural fistula. 37.7% of cases had associated subcutaneous emphysema. The median duration of PTX/PM from symptom onset was delayed at 22.5 and 17.6 days respectively. The mean CT severity score (CTSS) was 20.5 (± 4.9) with fibrosis (53.8%), bronchiectatic changes (50%) and cystic-cavitary changes (23%). There was no statistically significant difference between the spontaneous and barotrauma cohort. 71% of cases died and the majority belonged to the barotrauma cohort. It is imperative to consider the possibility of PTX/PM in patients having COVID-19, especially in those with deterioration in the disease course, both in spontaneously breathing and mechanically ventilated patients. These patients may also have a high incidence of death, reflecting the gravity of COVID-19.
Topics: COVID-19; Female; Humans; Male; Mediastinal Emphysema; Middle Aged; Pneumothorax; Respiration, Artificial; Retrospective Studies; SARS-CoV-2; Tertiary Healthcare
PubMed: 35034924
DOI: 10.5582/ddt.2021.01105 -
BMC Pulmonary Medicine Jan 2021Some patients with idiopathic pulmonary fibrosis (IPF) develop pneumothorax. However, the characteristics of pneumothorax in patients with IPF have not been elucidated....
BACKGROUND
Some patients with idiopathic pulmonary fibrosis (IPF) develop pneumothorax. However, the characteristics of pneumothorax in patients with IPF have not been elucidated. The purpose of this study was to clarify the clinical course, actual management, and treatment outcomes of pneumothorax in patients with IPF.
METHODS
Consecutive patients with IPF who were admitted for pneumothorax between January 2008 and December 2018 were included. The success rates of treatment for pneumothorax, hospital mortality, and recurrence rate after discharge were examined.
RESULTS
During the study period, 36 patients with IPF were admitted with pneumothorax a total of 58 times. During the first admission, 15 patients (41.7%) did not receive chest tube drainage, but 21 (58.3%) did. Of the 21 patients, 8 (38.1%) received additional therapy after chest drainage. The respective treatment success rates were 86.6% and 66.7% in patients who underwent observation only vs chest tube drainage. The respective hospital mortality rates were 13.3% and 38.0%. The total pneumothorax recurrence rate after hospital discharge was 34.6% (n = 9).
CONCLUSIONS
Pneumothorax in patients with IPF was difficult to treat successfully, had a relatively poor prognosis, and showed a high recurrence rate.
Topics: Aged; Aged, 80 and over; Drainage; Female; Hospital Mortality; Humans; Idiopathic Pulmonary Fibrosis; Japan; Logistic Models; Male; Pneumothorax; Recurrence; Retrospective Studies; Treatment Outcome
PubMed: 33407311
DOI: 10.1186/s12890-020-01370-w -
The Annals of Thoracic Surgery Mar 2014
Topics: Female; Humans; Male; Pneumothorax; Thoracic Surgery, Video-Assisted
PubMed: 24580913
DOI: 10.1016/j.athoracsur.2013.11.027 -
The Journal of Thoracic and... May 2018
Review
Topics: Clinical Decision-Making; Humans; Hydrostatic Pressure; Lung; Pleura; Pneumothorax; Prognosis; Respiration, Artificial; Respiratory Function Tests; Respiratory Mechanics; Risk Factors; Thoracic Surgical Procedures
PubMed: 29397977
DOI: 10.1016/j.jtcvs.2017.12.062 -
Journal of the National Medical... Mar 1974
Topics: Adolescent; Adult; Aged; Bronchoscopy; Child; Drainage; Female; Humans; Infant, Newborn; Male; Middle Aged; Pneumothorax; Recurrence; Rest
PubMed: 4819886
DOI: No ID Found -
Respiratory Medicine Oct 2021
Topics: Barotrauma; COVID-19; Humans; Pneumothorax; Respiration, Artificial; SARS-CoV-2
PubMed: 34364198
DOI: 10.1016/j.rmed.2021.106552 -
American Journal of Respiratory and... Jul 2022
Topics: Humans; Pneumothorax
PubMed: 35550016
DOI: 10.1164/rccm.202202-0271ED -
Sensors (Basel, Switzerland) Jun 2023Training with real patients is a critical aspect of the learning and growth of doctors in training. However, this essential step in the educational process for...
Training with real patients is a critical aspect of the learning and growth of doctors in training. However, this essential step in the educational process for clinicians can potentially compromise patient safety, as they may not be adequately prepared to handle real-life situations independently. Clinical simulators help to solve this problem by providing real-world scenarios in which the physicians can train and gain confidence by safely and repeatedly practicing different techniques. In addition, obtaining objective feedback allows subsequent debriefing by analysing the situation experienced and learning from other people's mistakes. This article presents SIMUNEO, a neonatal simulator in which professionals are able to learn by practicing the management of lung ultrasound and the resolution of pneumothorax and thoracic effusions. The article also discusses in detail the hardware and software, the main components that compose the system, and the communication and implementation of these. The system was validated through both usability questionnaires filled out by neonatology residents as well as through follow-up sessions, improvement, and control of the system with specialists of the department. Results suggest that the environment is easy to use and could be used in clinical practice to improve the learning and training of students as well as the safety of patients.
Topics: Infant, Newborn; Humans; Pneumothorax; Lung; Electrocardiography
PubMed: 37447813
DOI: 10.3390/s23135966 -
Tuberkuloz Ve Toraks Sep 2022Pneumothorax (PTX) and pneumomediastinum (PM) are frequently encountered in patients with Coronavirus disease 2019 (COVID-19) and complicate the management of these...
INTRODUCTION
Pneumothorax (PTX) and pneumomediastinum (PM) are frequently encountered in patients with Coronavirus disease 2019 (COVID-19) and complicate the management of these patients. In this study, we aimed to evaluate the risk factors that cause PTX/PM complications in patients hospitalized due to COVID-19 pneumonia and the effects of these complications on the course of the disease.
MATERIALS AND METHODS
A total of 503 patients with COVID-19 hospitalized in the COVID-19 ward or intensive care unit (ICU) between September 2020 and December 2020 were included in the study.
RESULT
The median age of patients was 65 (min-max, 21-99) years. Of the patients 299 (59.4%) were male and 204 (40.6%) were female. Of the cases, 26 (5.2%) developed PTX or PM. The patients who developed PTX/PM were older than patients who did not [58.5 (min-max, 21-96) vs 65 years (min-max, 22-99), p= 0.029]. The percentage of PTX/PM development was significantly higher in male patients [F/M= 4/22 (2/7.4%) vs 200/277 (98/92.6%), p= 0.007]. Hypertension as a comorbidity was more commonly seen in the group without PTX/PM (p= 0.007). Ground-glass opacity was the most common tomographic finding in both groups, it was significantly higher in those who did not develop PTX/PM (p<0.001). The length of hospital stay was shorter in patients with PTX/PM (p<0.001), but mortality was higher (p= 0.04).
CONCLUSIONS
PTX/PM were relatively more common in COVID-19 patients. These complications may negatively affect the prognosis of the disease.
Topics: Adult; Aged; Aged, 80 and over; COVID-19; Female; Hospitalization; Humans; Intensive Care Units; Male; Middle Aged; Pneumothorax; Retrospective Studies; Young Adult
PubMed: 36164952
DOI: 10.5578/tt.20229707