Pneumothorax

ABSTRACT

Pneumothoraces are classified as spontaneous, traumatic, and iatrogenic. Spontaneous pneumothoraces (SP) occur without recognized lung disease (primary, PSP) or due to an underlying lung disease (secondary, SSP). Treatment of PSP and SSP has been quite heterogeneous in the United States; adoption of the recently published American College of Chest Physicians guidelines will hopefully improve care. Central to these guidelines is the emphasis of observational management of a small pneumothorax in clinically stable PSP patients, and chest tube placement as key initial management in PSP or SSP patients who are unstable or have a large pneumothorax. Traumatic pneumothoraces due to penetrating or nonpenetrating (blunt) trauma usually require the placement of a larger-bore chest tube. Iatrogenic pneumothoraces appear most commonly due to transthoracic needle aspiration and may be treated in carefully selected patients with observation. The presence of underlying emphysema in the setting of an iatrogenic pneumothorax usually mandates placement of a drainage catheter. Newer mechanical ventilation modes and strategies may limit the development of positive pressure ventilation- related iatrogenic pneumothoraces.

KEYWORD

Pneumothorax - spontaneous - traumatic - iatrogenic - management

REFERENCES

• 1 Light R W, Broaddus V C. Pneumothorax, chylothorax, hemothorax, and fibrothorax. In: Murray JF, Nadel JA, Mason RJ, Boushey HA, eds. Textbook of Respiratory Medicine. 3rd ed. Philadelphia, Pa: WB Saunders 2000: 2043-2066
• 2 Sahn S A, Heffner J E. Spontaneous pneumothorax.  N Engl J Med . 2000;  342 868-874
• 3 Bense L, Lewander R, Eklund G, Hedenstierna G, Wiman L. Nonsmoking, non-alpha 1-antitrypsin deficiency-induced emphysema in nonsmokers with healed spontaneous pneumothorax, identified by computed tomography of the lungs.  Chest . 1993;  103 433-438
• 4 Bense L, Eklund G, Wiman L-G. Smoking and increased risk of contracting spontaneous pneumothorax.  Chest . 1987;  92 1009-1012
• 5 Cottin V, Streichenberger N, Gamondes J-P, Thevenet F, Loire R, Cordier J-F. Respiratory bronchiolitis in smokers with spontaneous pneumothorax.  Eur Respir J . 1998;  12 702-704
• 6 Melton L J, Hepper N GG, Offord K P. Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950-1974.  Am Rev Respir Dis . 1979;  120 1379-1382
• 7 Baumann M H, Strange C. Treatment of spontaneous pneumothorax: a more aggressive approach?.  Chest . 1997;  112 789-804
• 8 Baumann M H, Strange C. The clinician's perspective on pneumothorax management.  Chest . 1997;  112 822-828
• 9 Baumann M H, Strange C, Heffner J E. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement.  Chest . 2001;  119 590-602
• 10 Withers J, Fishback M, Kiehl P, Hannon J. Spontaneous pneumothorax.  Am J Surg . 1964;  108 772-776
• 11 Light R W. Management of spontaneous pneumothorax.  Am Rev Respir Dis . 1993;  148 245-248
• 12 Wait M A, Estrera A. Changing clinical spectrum of spontaneous pneumothorax.  Am J Surg . 1992;  164 528-531
• 13 Gupta D, Hansell A, Nichols T, Duong T, Ayres J G, Strachan D. Epidemiology of pneumothorax in England.  Thorax . 2000;  55 666-671
• 14 Videm V, Pillgram-Larsen J, Ellingsen O, Andersen G, Ovrum E. Spontaneous pneumothorax in chronic obstructive pulmonary disease: complications, treatment, and recurrences.  Eur J Respir Dis . 1987;  71 365-371
• 15 Maeda A, Ishioka S, Yoshihara M, Mihara M, Shigenobu T, Nakamura S. Primary spontaneous pneumothorax detected during a medical checkup.  Chest . 1999;  116 847-848
• 16 Kadokura M, Nonaka M, Yamamoto S. Five cases of asymptomatic spontaneous pneumothorax.  Ann Thorac Cardiovasc Surg . 1999;  5 187-190
• 17 Schramel F N H M, Golding R P, Haakman C DE, Sutedja T G, de Jong A K, Postmus P E. Expiratory chest radiographs do not improve visibility of small apical pneumothoraces by enhanced contrast.  Eur Respir J . 1996;  9 406-409
• 18 Bradley M, Williams C, Walshaw M. The value of routine expiratory chest films in the diagnosis of pneumothorax.  Arch Emerg Med . 1991;  8 115-116
• 19 Engdahl O, Toft T, Boe J. Chest radiograph: a poor method for determining size of a pneumothorax.  Chest . 1993;  103 26-29
• 20 Schramel F, Postmus P, Vanderschueren R. Current aspects of spontaneous pneumothorax.  Eur Respir J . 1997;  10 1372-1379
• 21 Light R W, O'Harra V S, Moritz T E. Intrapleural tetracycline for the prevention of recurrent spontaneous pneumothorax: results of a Department of Veterans Affairs cooperative study.  JAMA . 1990;  264 2224-2230
• 22 Lippert H, Lund O, Blegvad S, Larsen H. Independent risk factors for cumulative recurrence rate after first spontaneous pneumothorax.  Eur Respir J . 1991;  4 324-331
• 23 Kircher L T, Swartzel R L. Spontaneous pneumothorax and its treatment.  JAMA . 1954;  155 24-29
• 24 Chadha T S, Cohn M A. Noninvasive treatment of pneumothorax with oxygen inhalation.  Respiration . 1983;  44 147-152
• 25 Northfield T C. Oxygen therapy for spontaneous pneumothorax.  BMJ . 1971;  4 86-88
• 26 Moran J F, Jones R H, Wolfe W G. Regional pulmonary function during experimental unilateral pneumothorax in the awake state.  J Thorac Cardiovasc Surg . 1977;  74 396-402
• 27 Norris R M, Jones J G, Bishop J M. Respiratory gas exchange in patients with spontaneous pneumothorax.  Thorax . 1968;  23 427-433
• 28 O'Rourke J P, Yee E S. Civilian spontaneous pneumothorax: treatment options and long-term results.  Chest . 1989;  96 1302-1306
• 29 Soulsby T. British Thoracic Society guidelines for the management of spontaneous pneumothorax: do we comply with them and do they work?.  J Accid Emerg Med . 1998;  15 317-321
• 30 Miller A C, Harvey J E. Guidelines for the management of spontaneous pneumothorax.  BMJ . 1993;  307 114-116
• 31 Harvey J, Prescott R J. Simple aspiration versus intercostal tube drainage for spontaneous pneumothorax in patients with normal lungs.  BMJ . 1994;  309 1338-1339
• 32 Andrivet P, Djedaini K, Teboul J-L, Brochard L, Dreyfuss D. Spontaneous pneumothorax: comparison of thoracic drainage vs immediate or delayed needle aspiration.  Chest . 1995;  108 335-340
• 33 Baumann M H, Sahn S A. Medical management and therapy of bronchopleural fistulas in the mechanically ventilated patient.  Chest . 1990;  97 71-728
• 34 So S, Yu D. Catheter drainage of spontaneous pneumothorax: suction or no suction, early or late removal?.  Thorax . 1982;  37 46-48
• 35 Minami H, Saka H, Senda K. Small caliber catheter drainage for spontaneous pneumothorax.  Am J Med Sci . 1992;  304 345-347
• 36 Roney C W, Patel P, Petrini M, Baumann M H. Flow rates through commercially available pleural drainage catheters.  Chest . 2000;  118 256S
• 37 Patel P B, Petrini M, Baumann M H. Flow rates and suction levels in commercial pleural drainage units.  Am J Respir Crit Care Med . 2000;  161 A400
• 38 Miller A C. Treatment of spontaneous pneumothorax: the clinician's perspective on pneumothorax management.  Chest . 1998;  113 1423-1424
• 39 Baumann M H, Strange C. Treatment of spontaneous pneumothorax: the clinicians' perspective on pneumothorax management.  Chest . 1998;  113 1424-1425
• 40 Schoenenberger R A, Haefeli W E, Weiss P, Ritz R F. Timing of invasive procedures in therapy for primary and secondary spontaneous pneumothoraces.  Arch Surg . 1991;  126 764-766
• 41 Light R W. Pleural disease.  3rd ed. Baltimore, Md: Williams and Wilkins 1995: 242-277
• 42 Chee C BE, Abisheganaden J, Yeo J KS. Persistent air-leak in spontaneous pneumothorax-clinical course and outcome.  Respir Med . 1998;  92 757-761
• 43 Mathur R, Cullen J, Kinnear W JM, Johnston I DA. Time course of resolution of persistent air leak in spontaneous pneumothorax.  Respir Med . 1995;  89 129-132
• 44 Jain S K, Al-Kattan K M, Hamdy M. Spontaneous pneumothorax: determinants of surgical intervention.  J Cardiovasc Surg . 1998;  39 107-111
• 45 Matsuzoe D, Iwasaki A, Okabayashi K. Recurrence after thoracoscopic surgery for spontaneous pneumothorax.  Int Surg . 1999;  84 111-114
• 46 Waller D A, McConnell S A, Rajesh P B. Delayed referral reduces the success of video-assisted thoracoscopic surgery for spontaneous pneumothorax.  Respir Med . 1998;  92 246-249
• 47 Heffner J E, Standerfer R, Torstveit J, Unruh L. Clinical efficacy of doxycycline for pleurodesis.  Chest . 1994;  105 1743-1747
• 48 Kennedy L, Sahn S A. Talc pleurodesis for the treatment of pneumothorax and pleural effusion.  Chest . 1994;  106 1215-1222
• 49 Kennedy L, Vaughnan L M, Steed L L, Sahn S A. Sterilization of talc for pleurodesis: available techniques, efficacy, and cost analysis.  Chest . 1995;  107 1032-1034
• 50 Chappell A, Johnson A, Charles J. A survey of the long-term effects of talc and kaolin pleurodesis.  Br J Dis Chest . 1979;  73 285-288
• 51 Sahn S A. Talc should be used for pleurodesis.  Am J Respir Crit Care . 2000;  162 2023-2024
• 52 Light R W. Talc should not be used for pleurodesis.  Am J Respir Crit Care Med . 2000;  162 2024-2026
• 53 Ferrer J, Villarino M A, Tura J M, Traveria A, Light R W. Talc preparations used for pleurodesis vary markedly from one preparation to another.  Chest . 2001;  119 1901-1905
• 54 de Campos R M J, Vargas F S, Werebe E C. Thoracoscopy talc poudrage: a 15-year experience.  Chest . 2001;  119 801-806
• 55 Enderson B L, Abdalla R, Frame S B, Casey M T, Gould H, Maull K I. Tube thoracostomy for occult pneumothorax: a prospective randomized study of its use.  J Tramua . 1993;  35 726-30
• 56 Bridges K G, Welch G, Silver M, Schinco M A, Esposito B. CT detection of occult pneumothorax in multiple trauma patients.  J Emerg Med . 1993;  11 179-186
• 57 Wolfman N T, Myers W S, Glauser S J, Meredith J W, Chen M YM. Validity of CT classification on management of occult pneumothorax: a prospective study.  Am J Roentgenol . 1998;  171 1317-1320
• 58 Trupka A, Waydhas C, Hallfeldt K, Nast-Kolb D, Pfeifer K, Schweiberer L. Value of thoracic computed tomography in the first assessment of severely injured patients with blunt chest trauma: results of a prospective study.  J Tramua . 1997;  43 405-411
• 59 Weissberg D, Refaely Y. Pneumothorax: experience with 1,199 patients.  Chest . 2000;  117 1279-1285
• 60 Despars J A, Sassoon C SH, Light R W. Significance of iatrogenic pneumothoraces.  Chest . 1994;  105 1147-1150
• 61 Sznajder J I, Zveibil F R, Bitterman H, Weiner P, Bursztein S. Central vein catheterization: failure and complication rates by three percutaneous approaches.  Arch Intern Med . 1986;  146 259-261
• 62 Sassoon C SH, Light R W, O'Hara V S, Moritz T E. Iatrogenic pneumothorax: etiology and morbidity.  Respiration . 1992;  59 215-220
• 63 Berger R. Iatrogenic pneumothorax.  Chest . 1994;  105 980-982
• 64 Cox J E, Chiles C, McManus C M, Aquino S L, Choplin R H. Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax.  Radiology . 1999;  212 165-168
• 65 Fish G, Stanley J, Miller K S, Schable S, Sutherland S. Postbiopsy pneumothorax: estimating the risk by chest radiography and pulmonary function tests.  Am J Roentgenol . 1988;  150 71-74
• 66 Miller K, Fish G, Stanley J, Schabel S. Prediction of pneumothorax rate in percutaneous needle aspiration of the lung.  Chest . 1988;  93 742-745
• 67 Anderson C LV, Crespo J C, Lie T h. Risk of pneumothorax not increased by obstructive lung disease in percutaneous needle biopsy.  Chest . 1994;  105 1705-1708
• 68 Steier M, Ching N, Bonfils-Roberts E, Nealon T. Iatrogenic causes of pneumothorax: increasing incidence with advances in medical care.  N Y State J Med . 1973;  173 1296-1298
• 69 Amato M, Barbas C, Medeiros D. Effect of protective-ventilation strategy on mortality in the acute respiratory distress syndrome.  N Engl J Med . 1998;  338 347-354
• 70 Network ARDS. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome.  N Engl J Med . 2000;  342 1301-1308
• 71 Laronga C, Meric F, Truong M T, Mayfield C, Mansfield P. A treatment algorithm for pneumothoraces complicating central venous catheter insertion.  Am J Surg . 2000;  180 523-527
• 72 Brown K T, Brody L A, Getrajdman G I, Napp T E. Outpatient treatment of iatrogenic pneumothorax after needle biopsy.  Radiology . 1997;  205 49-252
• 73 Delius R E, Obeid F, Horst M, Sorensen V J, Fath J J, Bivins B A. Catheter aspiration for simple pneumothorax.  Arch Surg . 1989;  124 833-836
• 74 Schoenenberger R, Haefeli W, Weiss P, Ritz R. Evaluation of conventional chest tube therapy for iatrogenic pneumothorax.  Chest . 1993;  104 1770-1772