Evaluation of iatrogenic pneumothorax cases in the intensive care unit: A retrospective investigation (original) (raw)
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Pneumothorax in the Intensive Care Unit: Retrospective Analysis of Two Years’ Experience
Bagcilar Medical Bulletin
Pneumothorax is a common occurrence in intensive care unit (ICU)'s. Whereas causes of traumatic pneumothorax is generally blunt and penetrating traumas, iatrogenic pneumothorax may occur after procedures like central venous catheterization, positive-pressure mechanical ventilation and thoracentesis. Method: This study evaluated the data from 69 patients diagnosed with pneumothorax and followed up and treated in the ICU between the dates 01.01.2013 and 01.01.2015. The records were used to establish the patients' age, sex, Body Mass index and cause of pneumothorax, as well as the time of insertion of chest tube, total duration of chest tube and ICU length of stay. Pneumothorax patients were evaluated in two groups based on their etiologies as Traumatic Pneumothorax group (Group T) and Iatrogenic Pneumothorax group. Results: The pneumothorax incidence in our intensive care unit was found to be 2.53%, and all of the cases were acquired pneumothorax. Fifty-seven out of 69 cases were traumatic, most having developed bilaterally compared to the cases in the iatrogenic group, diagnosed with Computerized Tomography of Thorax and had a higher rate of thoracentesis. In Group T, chest tube was inserted earlier and mechanical ventilation duration and ICU length of stay were shorter. Conclusion: Pneumothorax is one of main emergency events in ICU patients. Even though it is rare, it should be diagnosed early. Our study confirms that pneumothorax in ICU is always acquired and mostly traumatic. Traumatic pneumothorax is associated with shorter mechanical ventilation duration and shorter ICU length of stay compared to iatrogenic pneumothorax.
Management of Pneumothorax in Emergency Medicine Departments: Multicenter Trial
Iranian Red Crescent Medical Journal, 2013
Background: Pneumothorax is common and life-threatening clinical condition which may require emergency treatment in Emergency Medicine Departments. Objectives: We aimed to reveal the epidemiological analysis of the patients admitted to the Emergency Department with pneumothorax. Material and Methods: This case-control and multi-center study was conducted in the patients treated with the diagnosis of pneumothorax between 01.01.2010-31.12.2010. Patient data were collected from hospital automation system. According to the etiology of the pneumothorax, study groups were arranged like spontaneous pneumothorax and traumatic pneumothorax. Results: 82.2% (n = 106) of patients were male and 17.8% (n = 23) of patients were female and mean age were 31.3 ± 20,2 (Minimum: 1, Maximum: 87). 68.2% (n = 88) of patients were spontaneous pneumothorax (61.36%, n=79 were primary spontaneous pneumothorax) and 31.8% (n = 41) of patients were traumatic pneumothorax (21.95% were iatrogenic pneumothorax). Main complaint is shortness of breath (52.3%, n=67) and 38% (n=49) of patients were smokers. Posteroanterior (PA) Chest X-Ray has been enough for 64.3% (n = 83) of the patients' diagnosis. Tube thoracostomy is applied to 84.5% (n = 109) of patients and surgery is applied to 9.3% (n = 12) of patients and 6.2% (n = 8) of patients were discharged with conservative treatment. Spontaneous pneumothorax showed statistically significant high recurrence compared with traumatic pneumothorax (P = 0.007). 4.65% of (n = 6) patients died. The average age of those who died (9.3 ± 19.9), statistically were significantly lower the mean age of living patients (32.4 ± 19.7) (t test, P = 0,006). 83.33% of the patients who died were neonatals and in the 0-1 years age group, and five of these patients were secondary spontaneous pneumothorax, and one of these patients were iatrogenic pneumothorax due to mechanical ventilation. Conclusions: Pneumothorax in adults can be treated by tube thoracostomy or surgically. Despite treatment, mortality of secondary and iatrogenic pneumothorax in newborns and 0-1 years age group is high.
OBJECTIVE: purpose of this study is to find the cause, management and outcome of patients presenting with pneumothorax in a thoracic medicine department METHODS: pneumothorax patients coming to treatment at thoracic medicine department at kilpauk medical college and GTHTM, otteri, Chennai during the period November 2019 to June 2021 were recruited and managed with appropriate intervention and outcome recorded. Patients of age above 12years were included. RESULTS: Total of 54 pneumothorax patients were evaluated for this study. The commonest management was intercostal drainage tube. The commonest cause and pulmonary tuberculosis. other causes include primary spontaneous tuberculosis, COPD, interstial lung disease and necrotising bacterial pneumonia. CONCLUSION: this study concludes that pulmonary tuberculosis and its related condition is the commonest cause of tuberculosis and intercostal drainage is commonest intervention for it in thoracic medicine department
Pneumothorax in the Intensive Care Unit
Anesthesiology, 2006
Background The risk factors and outcomes of critically ill patients with iatrogenic pneumothorax (IP) have not been studied in a large unselected intensive care unit (ICU) population. Methods The authors studied a prospective cohort of adults admitted for more than 24 h. Data were collected at ICU admission and daily by senior physicians until ICU discharge. Risk factors for IP were identified in the entire cohort. A matched nested case-control study was used to evaluate the excess risk of IP in decedents. Results Of the 3,499 patients, 69 with pneumothorax before ICU admission were excluded. Of the remaining 3,430 patients, 94 experienced IP within 30 days (42 due to barotrauma and 52 due to invasive procedures). The cumulative incidence of IP was 1.4% (95% confidence interval [CI], 1.0-1.8) on day 5 and 3.0% (95% CI, 2.4-3.6) on day 30. Risk factors for IP (hazard ratio [95% CI]) were body weight less than 80 kg (2.4 [1.3-4.2]), history of adult immunodeficiency syndrome (2.8 [1.2...
FREQUENCY AND MANAGEMENT OUTCOME OF PNEUMOTHORAX PATIENTS
Background: Primary spontaneous pneumothorax is a common clinical problem and its incidence is thought to be increasing. This study was conducted to see the frequency, aetiology, presentation and management outcomes of pneumothorax in patients presenting at Pulmonology unit, Ayub Teaching Hospital, Abbottabad, Pakistan. Methods: Pneumothorax patients reporting at the Pulmonology unit of Ayub Teaching Hospital, Abbottabad from 2002 to December 2008 were included in the study. Patients of all ages were included. They were admitted and followed up to the full recovery. Results: A total of 195 pneumothorax patients reported during this period. Majority of the patients were diagnosed to have pneumothorax due to pulmonary tuberculosis making about 36.92% of the total cases. Second most common cause was primary spontaneous pneumothorax (21.53%). COPD were also sizeable at 8.71%. Other causes included Bacterial infections, Asthma, iatrogenic, interstitial lung disease, bronchiectasis and Trauma. Conclusion: It was concluded from this study that pulmonary tuberculosis is the commonest cause of pneumothorax in our setup.
Clinical profile and treatment outcomes in pyo-pneumothorax in a tertiary care hospital
European Respiratory Journal, 2013
Body: AIMS AND OBJECTIVES The present study is undertaken to study the age-sex profile, symptomatology, microbiologic findings, etiology, management and treatment-outcome in new patients of pyopneumothorax. MATERIAL AND METHODS The prospective study on 55 new cases of pyopneumothorax was conducted in patients admitted at LRS Institute of Tuberculosis and Respiratory Diseases,New Delhi India.In all cases closed intercostal tube along with under water seal drainage was applied along with proper chemotherapy (antibiotics / anti-tubercular) and physiotherapy given according to need. Daily assessment of the progress in the cases was made and the cases who did not have satisfactory outcomes after 3 weeks, were evaluated for thoracic surgical intervention for further management. Surgery if required was done.Patient underwent surgical intervention followed up in the OPD to record the treatment outcomes. Results we found out majority of them were between 15 to 45 years.The male/ female ratio was 5:1.Chest pain and cough were most common symptoms. Tubercular and pyogenic ratio was 3:1,more frequently on the right side (52.6 %) and in three fourth of the tubercular cases the contra-lateral lung also showed active lesions. Mean duration of intercostal tube drainage was higher in the tubercular group (54 days) as against the non-tubercular group (32 days).Overall average duration of hospital stay is 63 days ranging from 10 to 140 days.We found 60% success rate in the management of pyopneumothorax with intercostal tube drainage only. The outcome of treatment was poor in the tubercular pyopneumothorax.
Management of Spontaneous Pneumothorax in Er of a Tertiary Care Hospital – an Observational Study
Zenodo (CERN European Organization for Nuclear Research), 2023
Introduction: Pneumothorax is an emergency having high mortality rate. Early recognition and management is crucial. Aim: To study the demographic data, clinical presentation, risk factor and management of cases of spontaneous pneumothorax presenting to ED. Material and Method: Observational analytical study done in 75 patients aged 20-74 years admitted at a tertiary care hospital from April 2018 to March 2019. Patients coming with spontaneous pneumothorx in ER were included in the study. History of trauma and iatrogenic causes were excluded. Result: Details about demographic data, clinical presentation, risk factor and management were recorded. Their main complaints were dyspnoea followed by chest pain. In our study out of 75 patients, ICD was inserted in 63 patients,7 patients managed with simple needle aspiration and 5 patients were treated conservatively. In our study 58 patients were shifted to E Ward/ICU, 8 patients were shifted to CT Sx ward, 5 patients shifted to ward, 3 patients took LAMA and 1 patient expired. Conclusion: In our study we found that SSP (secondary spontaneous pneumothorax) is more common than PSP (primary spontaneous pneumothorax), majority of patients were male and COPD (chronic obstructive pulmonary diseases) is the commonest cause of the SSP. Intercostal tube drainage is the main mode of management.
Pneumothorax Related to Mechanical Ventilation: Silent Enemy
Serbian Journal of Experimental and Clinical Research, 2016
Pneumothorax is well known and described complication in intensive care unit patients (ICU). Incidence of this complication is higher in patients with underlying pathology. As it can be occult, it is of the most importance to think of it in patients on mechanical ventilation. In this case report we well present ventilator-related pneumothorax in infant: clinical presentation, diagnosis and management