- Thoracic Surgery
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Clinical Characteristics of the Development of Pneumothorax in Mechanically Ventilated Patients in Intensive Care Units
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Wan Chul Kim, Su Jin Lim, Kyong Young Kim, Seung Jun Lee, Yu Ji Cho, Yi Yeong Jeong, Mi Jung Park, Kyoung Nyeo Jeon, Jong Deog Lee, Young Sil Hwang, Ho Cheol Kim
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Korean J Crit Care Med. 2014;29(1):13-18. Published online February 28, 2014
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DOI: https://doi.org/10.4266/kjccm.2014.29.1.13
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 Abstract
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- Background
Pneumothorax (PTX) can occur as a complication of positive pressure ventilation in mechanically ventilated patients.
Methods
We retrospectively reviewed the clinical characteristics of patients who developed PTX during mechanical ventilation (MV) in the intensive care unit (ICU).
Results
Of the 326 patients admitted (208 men and 118 women; mean age, 65.3 ± 8.74 years), 15 (4.7%) developed PTX, which was MV-associated in 11 (3.3%) cases (6 men and 5 women; mean age, 68.3 ± 9.12 years) and procedure-associated in 4. Among the patients with MV-associated PTX, the underlying lung diseases were acute respiratory distress syndrome in 7 patients, interstitial lung disease in 2 patients, and chronic obstructive pulmonary disease in 2 patients. PTX diagnosis was achieved by chest radiography alone in 9 patients and chest computed tomography alone in 2 patients. Nine patients were using assist-control mode MV with the mean applied positive end-expiratory pressure, 9 ± 4.6 cmH2O and the mean tidal volume, 361 ± 63.7 ml at the diagnosis of PTX. Two patients died as a result of MV-associated PTX and their systolic pressure was below 80 mmHg and heart rates were less than 80/min. Ten patients were treated by chest tube insertion, and 1 patient was treated by percutaneous pigtail catheter insertion.
Conclusions
PTX can develop in patients undergoing MV, and may cause death. Early recognition and treatment are necessary to prevent hemodynamic compromise in patients who develop PTX.
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