1
|
Issoufou I, Sani R, Amadou D, Alio K, Adamou-Nouhou K, Lakranbi M, Sani R, Ouadnouni Y, Abarchi H, Smahi M. Which Role for Muscle-Sparing Posterolateral Thoracotomy in the Treatment of Spontaneous Pneumothorax? Surg J (N Y) 2023; 9:e149-e155. [PMID: 38197090 PMCID: PMC10754642 DOI: 10.1055/s-0043-1770954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 05/26/2023] [Indexed: 01/11/2024] Open
Abstract
Objective This study aims to show the place of muscle-sparing posterolateral thoracotomy in the treatment of spontaneous pneumothorax. Methods It was a single-center study performed in the Department of Thoracic Surgery of Teaching hospital Hassan II of Fez for 8 years. We adopted the nosological definition, which classifies spontaneous pneumothorax into three categories. We included patients over 15 years of age with primary or secondary spontaneous pneumothorax operated by posterolateral thoracotomy without muscle section, and we analyzed the specific indications of this approach. It included 49 patients with primary or secondary spontaneous pneumothorax, operated by muscle-sparing posterolateral thoracotomy. Data were collected from regularly updated computer files of patients, entered by Excel 2013, and analyzed using SPSS.20 software. These data are: epidemiological, clinical, radiological, surgical exploration, surgical procedure, the result of the surgery and the evolution. Results The average age was 42 years. Smoking was found in 61% of cases and pulmonary tuberculosis in 10% of cases. Thoracic computed tomography (CT) showed bullae and blebs in 31% of cases, pleural adhesions and pachypleuritis in 50% of cases, and hydropneumothorax with pachypleuritis in 37% of cases. There is a statistical correlation between pleuropulmonary decortication and pachypleuritis ( p = 0.002) or hydropneumothorax ( p = 0.001) on CT. Bullae and blebs resection was performed in 53% of cases and pleuropulmonary decortication in 63% of cases. A right pleuropneumonectomy was performed in one case. The follow-up was uneventful in 82% of cases. Conclusion Muscle-sparing posterolateral thoracotomy remains the best approach and leads to good results.
Collapse
Affiliation(s)
- Ibrahim Issoufou
- Department of Thoracic Surgery, Teaching Hospital Hassan II, Fez, Morocco
| | - Rabiou Sani
- Department of Thoracic Surgery, Teaching Hospital Hassan II, Fez, Morocco
| | - Daouda Amadou
- Department of Cardiovascular Surgery, Teaching Hospital Hassan II, Fez, Morocco
| | - Kadre Alio
- Department of Stomatology and Maxillofacial Surgery, Hôpital Général de Référence, Niamey, Niger
- Department of Surgery and Surgical Specialities, Faculty of Health Sciences, Abdou Moumouni University, Niamey, Niger
| | - Kaled Adamou-Nouhou
- Department of Cardiovascular Surgery, Teaching Hospital Hassan II, Fez, Morocco
| | - Marouane Lakranbi
- Department of Thoracic Surgery, Teaching Hospital Hassan II, Fez, Morocco
- Department of Surgery, Faculty of Medicine and Pharmacy, University Sidi Mohamed Ben Adellah, Fez, Morocco
| | - Rachid Sani
- Department of Surgery and Surgical Specialities, Faculty of Health Sciences, Abdou Moumouni University, Niamey, Niger
- Department of General Surgery, National Hospital of Niamey, Niamey, Niger
| | - Yassine Ouadnouni
- Department of Thoracic Surgery, Teaching Hospital Hassan II, Fez, Morocco
- Department of Surgery, Faculty of Medicine and Pharmacy, University Sidi Mohamed Ben Adellah, Fez, Morocco
| | - Habibou Abarchi
- Department of Surgery and Surgical Specialities, Faculty of Health Sciences, Abdou Moumouni University, Niamey, Niger
- Department of Pediatric Surgery, Hospital Amirou Boubacar Diallo, Niamey, Niger
| | - Mohamed Smahi
- Department of Thoracic Surgery, Teaching Hospital Hassan II, Fez, Morocco
- Department of Surgery, Faculty of Medicine and Pharmacy, University Sidi Mohamed Ben Adellah, Fez, Morocco
| |
Collapse
|
2
|
Grasmuk-Siegl E, Valipour A. "Nitrogen Wash-Out" in Non-Hypoxaemic Patients with Spontaneous Pneumothorax: A Narrative Review. J Clin Med 2023; 12:4300. [PMID: 37445335 DOI: 10.3390/jcm12134300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Following current guidelines, spontaneous pneumothorax should be primarily managed with minimal invasive strategies. In real-world clinical practice, oxygen supplementation regardless of the presence or absence of hypoxemia is frequently applied in patients with a pneumothorax, with the intention to enhance the resorption rate of air from the pleural cavity ("nitrogen wash-out theory"). This review provides an overview of the scientific origin of this practice in animal models, and its clinical use in adult and paediatric patients. Clinical studies from PubMed, Embase and Cochrane library were reviewed by the authors using the keywords, "oxygen AND pneumothorax", "nitrogen washout AND pneumothorax" and "nitrogen AND pneumothorax", and recommendations from current guidelines were also reviewed by the authors. A selected total of nine clinical studies and three guidelines were included. Though in animal models there appears to be a therapeutic effect of oxygen therapy for the treatment of pneumothorax, clinical data in patient populations mainly stem from retrospective studies, mostly with a small sample size and inadequate study design. We recommend conducting prospective clinical studies with adequate methodology to address the question of whether or not oxygen therapy should be used to treat pneumothorax, regardless of the presence or absence of hypoxemia.
Collapse
Affiliation(s)
- Erwin Grasmuk-Siegl
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Brünner Straße 68, 1210 Vienna, Austria
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Health Care Group, Klinik Floridsdorf, Brünner Straße 68, 1210 Vienna, Austria
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Brünner Straße 68, 1210 Vienna, Austria
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Health Care Group, Klinik Floridsdorf, Brünner Straße 68, 1210 Vienna, Austria
| |
Collapse
|
3
|
Bernhard M, Keymel S, Krüger S, Pin M. [Acute dyspnea]. Dtsch Med Wochenschr 2023; 148:253-267. [PMID: 36848889 DOI: 10.1055/a-1817-7578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
ACUTE DYSPNEA The leading symptom "acute dyspnea" and the causal underlying diseases have a high risk potential for an unfavorable course of treatment with a high letality. This overview of possible causes, diagnostic procedures and guideline-based therapy is intended to help implement a targeted and structured emergency medical care in the emergency department. The leading symptom "acute dyspnea" is present in 10% of prehospital and 4-7% of patients in the emergency department. The most common conditions in the emergency department with the leading symptom "acute dyspnea" are heart failure in 25%, COPD in 15%, pneumonia in 13%, respiratory disorders in 8%, and pulmonary embolism in 4%. In 18% of cases, the leading symptom "acute dyspnea" is sepsis. The in-hospital letality is high and amounts to 9%. In critically ill patients in the non-traumatologic resuscitation room, respiratory disorders (B-problems) are present in 26-29%. In addition to cardiovascular disease, noncardiovascular disease may underlie "acute dyspnea" and requires differential diagnostic consideration. A structured approach can contribute to a high degree of certainty in the clarification of the leading symptom "acute dyspnea".
Collapse
|
4
|
Lung Ultrasound for the Exclusion of Pneumothorax after Interventional Bronchoscopies-A Retrospective Study. J Clin Med 2023; 12:jcm12041474. [PMID: 36836009 PMCID: PMC9967502 DOI: 10.3390/jcm12041474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
A chest X-ray (CXR) is recommended after bronchoscopies with an increased risk of pneumothorax (PTX). However, concerns regarding radiation exposure, expenses and staff requirements exist. A lung ultrasound (LUS) is a promising alternative for the detection of PTX, though data are scarce. This study aims to investigate the diagnostic yield of LUS compared to CXR, to exclude PTX after bronchoscopies with increased risk. This retrospective single-centre study included transbronchial forceps biopsies, transbronchial lung cryobiopsies and endobronchial valve treatments. Post-interventional PTX screening consisted of immediate LUS and CXR within two hours. In total, 271 patients were included. Early PTX incidence was 3.3%. Sensitivity, specificity, and the positive and negative predictive values of LUS were 67.7% (95% CI 29.93-92.51%), 99.2% (95% CI 97.27-99.91%), 75.0% (95% CI 41.16-92.79%) and 98.9% (95% CI 97.18-99.54%), respectively. PTX detection by LUS enabled the immediate placement of two pleural drains along with the bronchoscopy. With CXR, three false-positives and one false-negative were observed; the latter evolved into a tension-PTX. LUS correctly diagnosed these cases. Despite low sensitivity, LUS enables early diagnosis of PTX, thus preventing treatment delays. We recommend immediate LUS, in addition to LUS or CXR after two to four hours and monitoring for signs and symptoms. Prospective studies with higher sample sizes are needed.
Collapse
|
5
|
Neudecker J, Schulz-Drost S, Walles T. [Treatment of Persistent Parenchymal Lung Injuries in Thoracic Trauma: Lung Laceration, Pleural Fistula and Pneumothorax]. Zentralbl Chir 2023; 148:93-104. [PMID: 36822185 DOI: 10.1055/a-1898-7611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Thoracic trauma is a frequent injury pattern with high patient morbidity and mortality. Preclinical and clinical emergency treatment is consented in a national S3-guideline. Following emergency therapy one third of patients may develop lung lacerations, pleural fistulation and persisting pneumothorax. An interdisciplinary working group of the German Society for Thoracic Surgery and the German Society for Traumatology reviewed the published medical literature on treatment of those injuries and assessed the existing evidence according to consensus recommendations. An inconsistent classification of those subsequent lung injuries was found. Evidence for diagnostic and therapeutic recommendations is small.
Collapse
Affiliation(s)
- Jens Neudecker
- Chirurgische Klinik - Zentrum für Thoraxchirurgie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Stefan Schulz-Drost
- Klinik für Unfallchirurgie und Traumatologie, HELIOS Kliniken Schwerin, Schwerin, Deutschland
| | - Thorsten Walles
- Klinik für Herz- und Thoraxchirurgie, Abteilung Thoraxchirurgie, Otto-von-Guericke-Universität Magdeburg Medizinische Fakultät, Magdeburg, Deutschland
| |
Collapse
|
6
|
HTAD patient pathway: Strategy for diagnostic work-up of patients and families with (suspected) heritable thoracic aortic diseases (HTAD). A statement from the HTAD working group of VASCERN. Eur J Med Genet 2022; 66:104673. [PMID: 36460281 DOI: 10.1016/j.ejmg.2022.104673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/06/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022]
Abstract
Heritable thoracic aortic diseases (HTAD) are rare pathologies associated with thoracic aortic aneurysms and dissection, which can be syndromic or non-syndromic. They may result from genetic defects. Associated genes identified to date are classified into those encoding components of the (a) extracellular matrix (b) TGFβ pathway and (c) smooth muscle contractile mechanism. Timely diagnosis allows for prompt aortic surveillance and prophylactic surgery, hence improving life expectancy and reducing maternal complications as well as providing reassurance to family members when a diagnosis is ruled out. This document is an expert opinion reflecting strategies put forward by medical experts and patient representatives involved in the HTAD Rare Disease Working Group of VASCERN. It aims to provide a patient pathway that improves patient care by diminishing time to diagnosis, facilitating the establishment of a correct diagnosis using molecular genetics when possible, excluding the diagnosis in unaffected persons through appropriate family screening and avoiding overuse of resources. It is being recommended that patients are referred to an expert centre for further evaluation if they meet at least one of the following criteria: (1) thoracic aortic dissection (<70 years if hypertensive; all ages if non-hypertensive), (2) thoracic aortic aneurysm (all adults with Z score >3.5 or 2.5-3.5 if non-hypertensive or hypertensive and <60 years; all children with Z score >3), (3) family history of HTAD with/without a pathogenic variant in a gene linked to HTAD, (4) ectopia lentis without other obvious explanation and (5) a systemic score of >5 in adults and >3 in children. Aortic imaging primarily relies on transthoracic echocardiography with magnetic resonance imaging or computed tomography as needed. Genetic testing should be considered in those with a high suspicion of underlying genetic aortopathy. Though panels vary among centers, for patients with thoracic aortic aneurysm or dissection or systemic features these should include genes with a definitive or strong association to HTAD. Genetic cascade screening and serial aortic imaging should be considered for family screening and follow-up. In conclusion, the implementation of these strategies should help standardise the diagnostic work-up and follow-up of patients with suspected HTAD and the screening of their relatives.
Collapse
|
7
|
Hong W, Hwang EJ, Lee JH, Park J, Goo JM, Park CM. Deep Learning for Detecting Pneumothorax on Chest Radiographs after Needle Biopsy: Clinical Implementation. Radiology 2022; 303:433-441. [PMID: 35076301 DOI: 10.1148/radiol.211706] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Accurate detection of pneumothorax on chest radiographs, the most common complication of percutaneous transthoracic needle biopsies (PTNBs), is not always easy in practice. A computer-aided detection (CAD) system may help detect pneumothorax. Purpose To investigate whether a deep learning-based CAD system can improve detection performance for pneumothorax on chest radiographs after PTNB in clinical practice. Materials and Methods A CAD system for post-PTNB pneumothorax detection on chest radiographs was implemented in an institution in February 2020. This retrospective cohort study consecutively included chest radiographs interpreted with CAD assistance (CAD-applied group; February 2020 to November 2020) and those interpreted before implementation (non-CAD group; January 2018 to January 2020). The reference standard was defined by consensus reading by two radiologists. The diagnostic accuracy for pneumothorax was compared between the two groups using generalized estimating equations. Matching was performed according to whether the radiograph reader and PTNB operator were the same using the greedy method. Results A total of 676 radiographs from 655 patients (mean age: 67 years ± 11; 390 men) in the CAD-applied group and 676 radiographs from 664 patients (mean age: 66 years ± 12; 400 men) in the non-CAD group were included. The incidence of pneumothorax was 18.2% (123 of 676 radiographs) in the CAD-applied group and 22.5% (152 of 676 radiographs) in the non-CAD group (P = .05). The CAD-applied group showed higher sensitivity (85.4% vs 67.1%), negative predictive value (96.8% vs 91.3%), and accuracy (96.8% vs 92.3%) than the non-CAD group (all P < .001). The sensitivity for a small amount of pneumothorax improved in the CAD-applied group (pneumothorax of <10%: 74.5% vs 51.4%, P = .009; pneumothorax of 10%-15%: 92.7% vs 70.2%, P = .008). Among patients with pneumothorax, 34 of 655 (5.0%) in the non-CAD group and 16 of 664 (2.4%) in the CAD-applied group (P = .009) required subsequent drainage catheter insertion. Conclusion A deep learning-based computer-aided detection system improved the detection performance for pneumothorax on chest radiographs after lung biopsy. © RSNA, 2022 See also the editorial by Schiebler and Hartung in this issue.
Collapse
Affiliation(s)
- Wonju Hong
- From the Department of Radiology, Seoul National University Hospital, Seoul, Korea (W.H., E.J.H., J.H.L., J.P., J.M.G., C.M.P.); Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea (E.J.H., J.M.G., C.M.P.); and Cancer Research Institute, Seoul National University, Seoul, Korea (J.M.G., C.M.P.)
| | - Eui Jin Hwang
- From the Department of Radiology, Seoul National University Hospital, Seoul, Korea (W.H., E.J.H., J.H.L., J.P., J.M.G., C.M.P.); Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea (E.J.H., J.M.G., C.M.P.); and Cancer Research Institute, Seoul National University, Seoul, Korea (J.M.G., C.M.P.)
| | - Jong Hyuk Lee
- From the Department of Radiology, Seoul National University Hospital, Seoul, Korea (W.H., E.J.H., J.H.L., J.P., J.M.G., C.M.P.); Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea (E.J.H., J.M.G., C.M.P.); and Cancer Research Institute, Seoul National University, Seoul, Korea (J.M.G., C.M.P.)
| | - Jongsoo Park
- From the Department of Radiology, Seoul National University Hospital, Seoul, Korea (W.H., E.J.H., J.H.L., J.P., J.M.G., C.M.P.); Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea (E.J.H., J.M.G., C.M.P.); and Cancer Research Institute, Seoul National University, Seoul, Korea (J.M.G., C.M.P.)
| | - Jin Mo Goo
- From the Department of Radiology, Seoul National University Hospital, Seoul, Korea (W.H., E.J.H., J.H.L., J.P., J.M.G., C.M.P.); Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea (E.J.H., J.M.G., C.M.P.); and Cancer Research Institute, Seoul National University, Seoul, Korea (J.M.G., C.M.P.)
| | - Chang Min Park
- From the Department of Radiology, Seoul National University Hospital, Seoul, Korea (W.H., E.J.H., J.H.L., J.P., J.M.G., C.M.P.); Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea (E.J.H., J.M.G., C.M.P.); and Cancer Research Institute, Seoul National University, Seoul, Korea (J.M.G., C.M.P.)
| |
Collapse
|
8
|
Grott M, Eichhorn M, Eichhorn F, Schmidt W, Kreuter M, Winter H. Thoracic surgery in the non-intubated spontaneously breathing patient. Respir Res 2022; 23:379. [PMID: 36575519 PMCID: PMC9793515 DOI: 10.1186/s12931-022-02250-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 11/12/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The interest in non-intubated video-assisted thoracic surgery (NIVATS) has risen over the last decade and numerous terms have been used to describe this technique. They all have in common, that the surgical procedure is performed in a spontaneously breathing patient under locoregional anaesthesia in combination with intravenous sedation but have also been performed on awake patients without sedation. Evidence has been generated favouring NIVATS compared to one-lung-ventilation under general anaesthesia. MAIN BODY We want to give an overview of how NIVATS is performed, and which different techniques are possible. We discuss advantages such as shorter length of hospital stay or (relative) contraindications like airway difficulties. Technical aspects, for instance intraoperative handling of the vagus nerve, are considered from a thoracic surgeon's point of view. Furthermore, special attention is paid to the cohort of patients with interstitial lung diseases, who seem to benefit from NIVATS due to the avoidance of positive pressure ventilation. Whenever a new technique is introduced, it must prove noninferiority to the state of the art. Under this aspect current literature on NIVATS for lung cancer surgery has been reviewed. CONCLUSION NIVATS technique may safely be applied to minor, moderate, and major thoracic procedures and is appropriate for a selected group of patients, especially in interstitial lung disease. However, prospective studies are urgently needed.
Collapse
Affiliation(s)
- Matthias Grott
- grid.5253.10000 0001 0328 4908Department of Thoracic Surgery, Thoraxklinik, University Hospital Heidelberg, Roentgenstrasse 1, 69126 Heidelberg, Germany ,Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Martin Eichhorn
- grid.5253.10000 0001 0328 4908Department of Thoracic Surgery, Thoraxklinik, University Hospital Heidelberg, Roentgenstrasse 1, 69126 Heidelberg, Germany ,Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Florian Eichhorn
- grid.5253.10000 0001 0328 4908Department of Thoracic Surgery, Thoraxklinik, University Hospital Heidelberg, Roentgenstrasse 1, 69126 Heidelberg, Germany ,Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Werner Schmidt
- grid.5253.10000 0001 0328 4908Department of Anaesthesiology and Intensive Care Medicine, Thoraxklinik, University Hospital Heidelberg, Roentgenstrasse 1, 69126 Heidelberg, Germany
| | - Michael Kreuter
- Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Heidelberg, Germany ,grid.5253.10000 0001 0328 4908Center for Interstitial and Rare Lung Diseases, Pneumology Thoraxklinik, University Hospital Heidelberg, Roentgenstrasse 1, 69126 Heidelberg, Germany
| | - Hauke Winter
- grid.5253.10000 0001 0328 4908Department of Thoracic Surgery, Thoraxklinik, University Hospital Heidelberg, Roentgenstrasse 1, 69126 Heidelberg, Germany ,Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Heidelberg, Germany
| |
Collapse
|
9
|
Schmid M, Dodt C. Primärer Spontanpneumothorax – weniger ist manchmal mehr! Notf Rett Med 2021. [DOI: 10.1007/s10049-020-00743-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
10
|
Abstract
A pneumothorax is defined by the presence of free air between the pleura visceralis and the pleura partietalis. The lung separates from the chest wall, which then, depending on several parameters, leads to a slight or clinically threatening impairment of lung function. Non-specific signs such as thoracic pain or coughing are common and do not correlate with the extent of the pneumothorax. Almost without exception, the cause of this accumulation of air is a leakage in the lung's surface, which then results in air escaping into the pleural space. Depending on the cause of the "lung leakage", a distinction is made between a primary (idiopathic) spontaneous pneumothorax (PSP) that can be triggered without direct cause, and a secondary spontaneous pneumothorax (SSP) in case of an underlying known lung disease. Further between an iatrogenic pneumothorax in connection with a lung injury caused by medical measures, and a traumatic pneumothorax in the case of an accident-related lung tear. The relevant therapeutic goals are the elimination of the acute symptoms, the reliable achievement of re-expansion of the lungs, and, after appropriate information gathering about the probability and clinical significance of a pneumothorax recurrence and depending on the patient's wish, avoiding a recurrence by means of surgical measures. The therapy options range from a "wait-and-see" procedure, that merely monitors the findings, to a primary video-assisted thoracoscopic surgical therapy with detection and resection of the superficial lung lesion, as well as a measurement to obliterate the pleural cavity that prevents relapse. Regarding "follow-up care" or even behavioral recommendations after a pneumothorax, there are no recommendations that reduce the risk of recurrence.
Collapse
|
11
|
Jany B, Welte T. Pleural Effusion in Adults-Etiology, Diagnosis, and Treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:377-386. [PMID: 31315808 DOI: 10.3238/arztebl.2019.0377] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 01/14/2019] [Accepted: 05/06/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pleural effusion is common in routine medical practice and can be due to many different underlying diseases. Precise differential diagnostic categorization is essential, as the treatment and prognosis of pleural effusion largely depend on its cause. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed and on the authors' personal experience. RESULTS The most common causes of pleural effusion are congestive heart failure, cancer, pneumonia, and pulmonary embolism. Pleural fluid puncture (pleural tap) enables the differentiation of a transudate from an exudate, which remains, at present, the foundation of the further diagnostic work-up. When a pleural effusion arises in the setting of pneumonia, the potential devel- opment of an empyema must not be overlooked. Lung cancer is the most common cause of malignant pleural effusion, followed by breast cancer. Alongside the treatment of the underlying disease, the specific treatment of pleural effusion ranges from pleurodesis, to thoracoscopy and video-assisted thoracoscopy (with early consultation of a thoracic surgeon), to the placement of a permanently indwelling pleural catheter. CONCLUSION The proper treatment of pleural effusion can be determined only after meticulous differential diagnosis. The range of therapeutic options has recently become much wider. More data can be expected in the near future concerning diagnostic test- ing for the etiology of the effusion, better pleurodetic agents, the development of interventional techniques, and the genetic background of the affected patients.
Collapse
Affiliation(s)
- Berthold Jany
- Julius-Maximilians-Universität Würzburg, Klinikum Würzburg Mitte, Missioklinik, Department of Pneumology; Department of Respiratory Medicine, Hannover Medical School
| | | |
Collapse
|
12
|
Hempel D, Michels G. [Sonography in intensive care and emergency medicine : A new training concept]. Med Klin Intensivmed Notfmed 2020; 116:301-306. [PMID: 32318820 DOI: 10.1007/s00063-020-00688-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/02/2020] [Accepted: 03/26/2020] [Indexed: 01/20/2023]
Abstract
Structured sonography training in internal medicine intensive care and emergency medicine (SIN) comprises two levels and was proposed by three national societies in Germany (DGIIN, DGK and DEGUM). The curriculum consists of a basic level (SIN-I) and an expert level (SIN-II) which are consecutive levels teaching both theoretical and hands-on skills using a symptom-based approach. Competency is assessed using written, oral and practical structured assessments at the end of each level. The goal is to implement national and international recommendations regarding the use of point-of-care ultrasound into clinical practice.
Collapse
Affiliation(s)
- D Hempel
- Zentrale Notaufnahme und Aufnahmestation, Universitätsklinik Magdeburg, Magdeburg, Deutschland
| | - G Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital Eschweiler, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland.
| |
Collapse
|
13
|
Mukhtar O, Shrestha B, Khalid M, Alhafdh O, Datar P, Bhattarai B, Bakhiet M, Gayam V, Khalid M, Quist J, Enriquez D, Schmidt F. Characteristics of 30-day readmission in spontaneous pneumothorax in the United States: a nationwide retrospective study. J Community Hosp Intern Med Perspect 2019; 9:215-220. [PMID: 31258860 PMCID: PMC6586084 DOI: 10.1080/20009666.2019.1618135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/06/2019] [Indexed: 11/08/2022] Open
Abstract
Objective: Our study aimed to determine the national estimates of the 30-day all-cause readmission rate among patients with spontaneous pneumothorax and to investigate the burden of these readmissions in terms of mortality, length of stay and hospitalization costs in the USA. Methods: We utilized the Nationwide Readmission Database for 2013–2014 and identified adults with a primary diagnosis of spontaneous pneumothorax. We analyzed and reported patient- and hospital-level variables of the study cohort. Our primary outcome was 30-day readmission rate, including the reasons for readmission. Our secondary outcomes included all-cause mortality, resources utilization and predictors of readmissions. Results: We identified 47,108 index admissions with spontaneous pneumothorax. The 30-day readmission rate was 13.6%. The most common reason for admission was recurrent pneumothorax. In index admissions, the in-hospital mortality rate was 3.1%; whereas, in readmissions, the mortality was higher (4.6%, p < 0.001). Both age group 45–64 (HR: 1.31, 95% CI: [1.15–1.49], p < 0.001) and history of cancer (HR: 1.34, 95% CI: [1.17–1.53], p < 0.001) were found to predict the risk of 30-day readmission. Conclusion: The 30-day readmission rate in patients with spontaneous pneumothorax was 13.6%, and a recurrent event was the most likely cause. The 30-day readmissions were associated with higher mortality and hospitalization charges. Middle age and history of cancer increase likelihood of 30-day readmission.
Collapse
Affiliation(s)
- Osama Mukhtar
- Pulmonary Division, Interfaith Medical Center, Brooklyn, NY, USA
| | - Binav Shrestha
- Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA
| | - Mazin Khalid
- Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA
| | - Oday Alhafdh
- Pulmonary Division, Interfaith Medical Center, Brooklyn, NY, USA
| | - Praveen Datar
- Pulmonary Division, Interfaith Medical Center, Brooklyn, NY, USA
| | - Bikash Bhattarai
- Pulmonary Division, Interfaith Medical Center, Brooklyn, NY, USA
| | - Manal Bakhiet
- Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA
| | - Vijay Gayam
- Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA
| | - Mowyad Khalid
- Department of Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - Joseph Quist
- Pulmonary Division, Interfaith Medical Center, Brooklyn, NY, USA
| | - Danilo Enriquez
- Pulmonary Division, Interfaith Medical Center, Brooklyn, NY, USA
| | - Frances Schmidt
- Pulmonary Division, Interfaith Medical Center, Brooklyn, NY, USA
| |
Collapse
|