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Liao KM, Chiu CC, Lu HY. The risk of secondary spontaneous pneumothorax in patients with chronic obstructive pulmonary disease in Taiwan. Respir Med 2024; 228:107672. [PMID: 38763446 DOI: 10.1016/j.rmed.2024.107672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 05/12/2024] [Accepted: 05/16/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Secondary spontaneous pneumothorax (SSP) is often linked to chronic obstructive pulmonary disease (COPD). The frequency of SSP occurrence in COPD patients varies among different research findings. SSPs are more commonly found in the elderly population diagnosed with COPD. Previous studies have reported a pneumothorax rate of 26 per 100,000 COPD patients. There is, however, a notable lack of detailed epidemiological information regarding SSP in Asia. Our study focused on determining the occurrence rate of SSP among COPD patients in Taiwan using an extensive national database. Additionally, this study aimed to identify comorbidities associated with SSP in this patient group. METHODS In this study, we used the Longitudinal Health Insurance Database, which contains records of 2 million people who were randomly chosen from among the beneficiaries of the Taiwan National Health Insurance program. The dataset includes information from 2005 to the end of 2017. Our focus was on individuals diagnosed with COPD, identified through ICD-9-CM codes in at least one hospital admission or two outpatient services, with the COPD diagnosis date as the index date. The exclusion criteria included individuals younger than 40 years, those with incomplete records, or those with a previous diagnosis of pneumothorax before the index date. We conducted a matched comparison by pairing COPD patients with control subjects of similar age, sex, and comorbidities using propensity score matching. The follow-up for all participants started from their index date and continued until they developed pneumothorax, reached the study's end, withdrew from the insurance program, or passed away. The primary objective was to evaluate and compare the incidence of pneumothorax between COPD patients and matched controls. RESULTS We enrolled 65,063 patients who were diagnosed with COPD. Their mean age (±SD) was 66.28 (±12.99) years, and approximately 60 % were male. During the follow-up period, pneumothorax occurred in 607 patients, equivalent to 9.3 % of the cohort. The incidence rate of SSP in COPD patients was 12.10 per 10,000 person-years, whereas it was 6.68 per 10,000 person-years in those without COPD. Furthermore, COPD patients with comorbidities such as atrial fibrillation, congestive heart failure, coronary artery disease, diabetes mellitus, hypertension, and cancer exhibited an increased incidence of SSP compared to COPD patients without such comorbidities. This was observed after conducting a multivariable Cox regression analysis adjusted for age, sex, and other comorbidities. CONCLUSION Our study revealed an elevated risk of SSP in patients with COPD. It has also been suggested that COPD patients with comorbidities, such as atrial fibrillation, congestive heart failure, coronary artery disease, diabetes mellitus, hypertension, and cancer, have an increased risk of developing SSP.
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Affiliation(s)
- Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan; Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Chong-Chi Chiu
- Department of General Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Department of Medical Education and Research, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Hsueh-Yi Lu
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yun-Lin, Taiwan.
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Owen GS, Harmon KA, Sullivan GA, Petit HJ, Westrick J, Cameron JR, Gulack BC, Shah AN. Methods of measurement for pneumothorax in pediatric patients: a systematic review. Pediatr Surg Int 2024; 40:77. [PMID: 38472473 DOI: 10.1007/s00383-024-05640-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 03/14/2024]
Abstract
Accurate measurement of pneumothorax (PTX) size is necessary to guide clinical decision making; however, there is no consensus as to which method should be used in pediatric patients. This systematic review seeks to identify and evaluate the methods used to measure PTX size with CXR in pediatric patients. A systematic review of the literature through 2021 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was conducted using the following databases: Ovid/MEDLINE, Scopus, Cochrane Database of Controlled Trials, Cochrane Database of Systematic Reviews, and Google Scholar. Original research articles that included pediatric patients (< 18 years old) and outlined the PTX measurement method were included. 45 studies were identified and grouped by method (Kircher and Swartzel, Rhea, Light, Collins, Other) and societal guideline used. The most used method was Collins (n = 16; 35.6%). Only four (8.9%) studies compared validated methods. All found the Collins method to be accurate. Seven (15.6%) studies used a standard classification guideline and 3 (6.7%) compared guidelines and found significant disagreement between them. Pediatric-specific measurement guidelines for PTX are needed to establish consistency and uniformity in both research and clinical practice. Until there is a better method, the Collins method is preferred.
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Affiliation(s)
- Grant S Owen
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Kelly A Harmon
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Gwyneth A Sullivan
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, 1653 W. Congress Parkway, Suite 794, Chicago, IL, 60612, USA
| | - Hayley J Petit
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Jennifer Westrick
- Library of Rush Medical Center, Rush University Medical Center, Chicago, IL, USA
| | - James R Cameron
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Brian C Gulack
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, 1653 W. Congress Parkway, Suite 794, Chicago, IL, 60612, USA
| | - Ami N Shah
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, 1653 W. Congress Parkway, Suite 794, Chicago, IL, 60612, USA.
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Hunter JG, Pierce JD, Gilkeson RC, Bera K, Gupta A. Clinical Implementation of an Artificial Intelligence Tool in the Detection and Management of Pneumothoraces in Patients With COVID-19. Cureus 2023; 15:e42509. [PMID: 37637593 PMCID: PMC10457148 DOI: 10.7759/cureus.42509] [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] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
In this report, we present a series involving critically ill patients with known coronavirus disease (COVID-19) infection where a portable X-ray machine equipped with artificial intelligence (AI) software aided in the urgent radiographic diagnosis of pneumothorax. These cases demonstrate how real-world clinical employment of AI tools capable of analyzing and prioritizing studies in the radiologist's worklist can potentially lead to earlier detection of emergent findings like pneumothorax. The use of AI tools in this manner has the potential to both improve radiology workflow and add significant clinical value in managing critically ill patient populations, such as those with severe COVID-19 infection.
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Affiliation(s)
- Joshua G Hunter
- Radiology, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Jonathan D Pierce
- Radiology, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Robert C Gilkeson
- Radiology, University Hospitals Cleveland Medical Center, Cleveland, USA
- Radiology, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Kaustav Bera
- Radiology, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Amit Gupta
- Radiology, University Hospitals Cleveland Medical Center, Cleveland, USA
- Radiology, Case Western Reserve University School of Medicine, Cleveland, USA
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Chimeli-Ormonde L, Vasconcelos LHF, Silva RRA, Bastos PSP. Spontaneous pneumomediastinum in a young adult female. J Radiol Case Rep 2022; 16:8-13. [PMID: 36353291 PMCID: PMC9629801 DOI: 10.3941/jrcr.v16i10.4565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Spontaneous pneumomediastinum is characterized by the accumulation of air in the mediastinum with no identified cause. It is a rare and self-limiting condition. We report the case of a 32-year-old female patient with controlled bronchial asthma, who presented with spontaneous pneumomediastinum, with no precipitating event. The evolution is generally benign and the treatment is conservative. Symptomatic medication may be instituted.
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Affiliation(s)
- Luiza Chimeli-Ormonde
- Hospital Municipal Ronaldo Gazolla - Av. Pastor Martin Luther King Júnior, 10.976 - Acari, Rio de Janeiro - RJ, 21531-010, Brazil
- Correspondence: Luiza Chimeli-Ormonde, Institution and postal mail: Hospital Municipal Ronaldo Gazolla - Av. Pastor Martin Luther King Júnior, 10.976 - Acari, Rio de Janeiro - RJ, 21531-010, Brazil, ()
| | | | - Roberto Rangel Alves Silva
- Hospital Municipal Ronaldo Gazolla - Av. Pastor Martin Luther King Júnior, 10.976 - Acari, Rio de Janeiro - RJ, 21531-010, Brazil
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Dhanasopon AP, Blasberg JD, Mase VJ. Surgical Management of Pneumothorax and Pleural Space Disease. Surg Clin North Am 2022; 102:413-427. [PMID: 35671764 DOI: 10.1016/j.suc.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pleural space diseases constitute a wide range of benign and malignant conditions, including pneumothorax, pleural effusion and empyema, chylothorax, pleural-based tumors, and mesothelioma. The focus of this article is the surgical management of the 2 most common pleural disorders seen in modern thoracic surgery practice: spontaneous pneumothorax and empyema.
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Affiliation(s)
- Andrew P Dhanasopon
- Division of Thoracic Surgery, Yale School of Medicine, Yale University School of Medicine, PO Box 208062, New Haven, CT 06520-8062, USA
| | - Justin D Blasberg
- Division of Thoracic Surgery, Yale School of Medicine, Yale University School of Medicine, PO Box 208062, New Haven, CT 06520-8062, USA
| | - Vincent J Mase
- Division of Thoracic Surgery, Yale School of Medicine, Yale University School of Medicine, PO Box 208062, New Haven, CT 06520-8062, USA.
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Ata F, Yousaf Z, Farsakoury R, Khan AA, Arshad A, Omran M, Ananthegowda DC, Khatib M, Chughtai TS. Spontaneous tension pneumothorax as a complication of Coronavirus disease 2019: Case report and literature review. Clin Case Rep 2022; 10:e05852. [PMID: 35582160 PMCID: PMC9083808 DOI: 10.1002/ccr3.5852] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022] Open
Abstract
Primary spontaneous tension pneumothorax (STP) is a rare and life‐threatening condition. We report a case of COVID‐19‐pneumonia patient who developed STP as a complication. He had a prolonged hospital stay and was ultimately discharged asymptomatic. A systematic literature search was performed to review studies (N=12) reporting STP in the setting of COVID‐19.
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Affiliation(s)
- Fateen Ata
- Department of Internal Medicine Hamad General Hospital Hamad Medical Corporation Doha Qatar
| | - Zohaib Yousaf
- Department of Internal Medicine Hamad General Hospital Hamad Medical Corporation Doha Qatar
| | - Rana Farsakoury
- Department of Plastic Surgery Hamad General Hospital Hamad Medical Corporation Doha Qatar
| | - Adeel Ahmad Khan
- Department of Endocrinology Hamad General Hospital Hamad Medical Corporation Doha Qatar
| | - Abdullah Arshad
- Department of Internal Medicine Hamad General Hospital Hamad Medical Corporation Doha Qatar
| | - Maya Omran
- Medical Intensive Care Unit Hazm Mebaireek Hospital Hamad Medical Corporation Doha Qatar
| | | | - Mohamad Khatib
- Medical Intensive Care Unit Hazm Mebaireek Hospital Hamad Medical Corporation Doha Qatar
| | - Talat Saeed Chughtai
- Trauma Surgery and Thoracic Surgery Hamad General Hospital Hamad Medical Corporation Doha Qatar
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Tran J, Haussner W, Shah K. Traumatic Pneumothorax: A Review of Current Diagnostic Practices And Evolving Management. J Emerg Med 2021; 61:517-528. [PMID: 34470716 DOI: 10.1016/j.jemermed.2021.07.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/28/2021] [Accepted: 07/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pneumothorax (PTX) is defined as air in the pleural space and is classified as spontaneous or nonspontaneous (traumatic). Traumatic PTX is a common pathology identified in the emergency department. Traditional management calls for chest x-ray (CXR) diagnosis and large-bore tube thoracostomy, although recent literature supports the efficacy of lung ultrasound (US) and more conservative approaches. There is a paucity of cohesive literature on how to best manage the traumatic PTX. OBJECTIVE OF THE REVIEW This review aimed to describe current practices and future directions of traumatic PTX management. DISCUSSION Lung US has proven to be a potentially more useful tool in the detection of PTX in the trauma bay compared with CXR, and has the potential to become the new gold standard for diagnosing traumatic PTX. Computed tomography remains the ultimate gold standard, although in the setting of trauma, its utility lies more in confirming the presence and measuring the size of a PTX. The traditional mantra calling for large-bore chest tubes as first-line approaches to traumatic PTX is challenged by recent literature demonstrating pigtail catheters as equally efficacious alternatives. In patients with small or occult PTXs, even observation may be reasonable. CONCLUSIONS Modern management of the traumatic PTX is shifting toward use of US for diagnosis and more conservative management practices (smaller catheters or observation). Ultimately, this shift is favorable in reducing length of stay, development of complications, and pain in the trauma patient.
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Affiliation(s)
- Jacqueline Tran
- Weill Cornell Medicine, Weill Cornell Medical College, New York, New York
| | - William Haussner
- Weill Cornell Medicine, Emergency Medicine, New-York Presbyterian Hospital, New York, New York
| | - Kaushal Shah
- Weill Cornell Medicine, Emergency Medicine, New-York Presbyterian Hospital, New York, New York
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Hein S, Kappes J. [Update on primary spontaneous pneumothorax - conservative or primarily surgical therapy?]. Dtsch Med Wochenschr 2021; 146:994-997. [PMID: 34344027 DOI: 10.1055/a-1272-9512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Spontaneous pneumothorax is a potentially life-threatening situation. Therefore, it is mandatory to treat it safely. The incidence is approximately 10 out of 100 000 residents per year. It occurs through an immediate disruption of the visceral pleura that results in an accumulation of air in the pleural space. According to its etiology, spontaneous pneumothorax is divided into 2 groups. Whereas primary spontaneous pneumothorax occurs in healthy individuals without any detectable lung disease, secondary spontaneous pneumothorax occurs in patients with preexisting. Diagnosis of pneumothorax is typically made by chest x-ray. After diagnosis pneumothorax is traditionally treated by an insertion of a thoracic tube.Recently, thoracic ultrasound gained influence in diagnosis of pneumothorax and primarily conservative treatment strategies have been shown to be safe and equally effective in particular groups of patients. This article aims to present and discuss these upcoming strategies.
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Affiliation(s)
- Selina Hein
- Katholisches Klinikum Koblenz-Montabaur, Klinik für Innere Medizin/Pneumologie, Schlaf- und Beatmungsmedizin Koblenz
| | - Jutta Kappes
- Katholisches Klinikum Koblenz-Montabaur, Klinik für Innere Medizin/Pneumologie, Schlaf- und Beatmungsmedizin Koblenz
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Giles AE, Kidane B, Schellenberg M, Ball CG. The Primary Spontaneous Pneumothorax trial: A critical appraisal from the surgeon's perspective. J Thorac Cardiovasc Surg 2021; 162:1428-1432. [PMID: 33773816 DOI: 10.1016/j.jtcvs.2021.02.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/07/2021] [Accepted: 02/12/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Andrew E Giles
- Section of Thoracic Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Biniam Kidane
- Section of Thoracic Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Research Institute in Oncology & Hematology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada.
| | - Morgan Schellenberg
- Division of Acute Care Surgery, LAC + USC Medical Center, Los Angeles, Calif
| | - Chad G Ball
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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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.
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Pradana A. Spontaneous Tuberculosis-Associated Tension Pneumothorax: A Case Report and Literature Review. CASE REPORTS IN ACUTE MEDICINE 2020. [DOI: 10.1159/000508530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Secondary spontaneous pneumothorax (SSP) is one of the major complications of pulmonary tuberculosis (TB), and it can be a life-threatening condition if it progresses to tension pneumothorax. A correct initial assessment and prompt intervention will prevent a hemodynamic deterioration in tension pneumothorax. Needle decompression followed by large-bore chest tube insertion is usually required in the management of SSP. We present a case of spontaneous TB-associated tension pneumothorax in a young adult which resolved with needle decompression without chest tube insertion.
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Thomas A, Wilkinson KH, Young K, Lenz T, Theobald J. Complications from Needle Thoracostomy: Penetration of the Myocardium. PREHOSP EMERG CARE 2020; 25:438-440. [PMID: 32437217 DOI: 10.1080/10903127.2020.1772419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We report a rare but serious complication of needle thoracostomy, penetration of the myocardium. Needle thoracostomy is typically performed in the prehospital setting or upon arrival in the emergency department for suspected tension pneumothorax. Needle decompression is generally taught and done anteriorly, in the 2nd intercostal space on the midclavicular line (MCL). An alternative approach is laterally, along the anterior axillary line (AAL) in the 4th intercostal space. Our case supports prior literature that the anterior MCL location has a low rate of efficacy to decompress the chest, as well as a high rate of complications. We recommend performing needle decompression laterally at the AAL whether in the field or in the emergency department.
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Inocencio M, Childs J, Chilstrom ML, Berona K. Ultrasound Findings in Tension Pneumothorax: A Case Report. J Emerg Med 2017; 52:e217-e220. [DOI: 10.1016/j.jemermed.2017.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 02/14/2017] [Indexed: 11/24/2022]
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Loftus NW, Bowden T. Tension pneumothorax recurrence in COPD: a care study. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2016; 25:1058-1063. [PMID: 27792446 DOI: 10.12968/bjon.2016.25.19.1058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This care study concerns a patient with chronic obstructive pulmonary disease, who endures the recurrence of a tension pneumothorax. A holistic and evidence-based approach is employed to critically discuss his assessment, pathophysiology, and nursing care. These discussions facilitate extrapolation of implications pertinent to nursing practice.
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Affiliation(s)
| | - Tracey Bowden
- Senior Lecturer in Adult Nursing, City University of London
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