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Kecskes G, Szabo A, Sutori D, Maroti P, Marovics G, Molnar TF. Pneumothorax/pneumomediastinum and pre-existing lung pathology in ventilated COVID-19 patients: a cohort study. J Thorac Dis 2022; 14:4733-4740. [PMID: 36647498 PMCID: PMC9840012 DOI: 10.21037/jtd-22-817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 10/21/2022] [Indexed: 11/13/2022]
Abstract
Background There is an increasing number of reports on developing pneumothorax/pneumomediastinum among severe acute respiratory syndrome coronavirus disease 2019 (SARS-COVID-19) patients. The aim of our study was whether pre-existing diffuse lung pathology increases visceral pleural vulnerability resulting in pneumomediastinum and pneumothorax among mechanically ventilated COVID-19 patients? Methods A total of 138 consecutive COVID-19 patients admitted to the Intensive Care Unit of Petz Aladár University Teaching Hospital between 1st March 2020 and 1st February 2021 were included. Sixty/138 (43.48%) patients had one or more computer tomography scans of the chest. Analysis was focused on the image defined lung conditions during artificial ventilation. Results Thirteen out of 60 ventilated patients developed pneumothorax or pneumomediastinum proven by computer tomography (9.42%). Three/13 patients suffered from pre-existing lung parenchyma pathology, while 10/13 had only COVID-19 infection-related image abnormality. Forty-three/60 patient had healthy lung pre-COVID. Kruskal-Wallis test, Spearman correlation and Cox regression calculations did not reveal any statistically significant result proving increased vulnerability during pressure support therapy and visceral pleural breakdown in patients with pre-existing lung pathologies. Conclusions Pre-existing lung pathology does not increase the risk of onset of pneumothorax or pneumomediastinum in comparation with previously healthy lungs of ventilated COVID-19 patients.
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Affiliation(s)
- Gabriella Kecskes
- Department of Anaesthesiology and Intensive Care, Petz A University Teaching Hospital, Győr, Hungary
| | - Albert Szabo
- Department of Radiology, Petz A University Teaching Hospital, Győr, Hungary
| | - David Sutori
- St. Sebastian Thoracic Surgery Unit, University Teaching Hospital, University of Pécs, Győr, Hungary
| | - Peter Maroti
- Department of Public Health Medicine, University of Pécs, Pécs, Hungary
| | - Gergely Marovics
- Department of Public Health Medicine, University of Pécs, Pécs, Hungary
| | - Tamas F. Molnar
- St. Sebastian Thoracic Surgery Unit, University Teaching Hospital, University of Pécs, Győr, Hungary;,Department of Operational Medicine, Faculty of Medicine, University of Pécs, Pécs, Hungary
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Kajenthiran R, Tiwary MK, Lal A, Paul J, Al Sawafi F, Manhas Y, Yadav A, Al Harthi Z, Nair A. Pulmonary Barotrauma in COVID-19 Patients: Experience From a Secondary Care Hospital in Oman. Cureus 2022; 14:e26414. [PMID: 35911291 PMCID: PMC9335402 DOI: 10.7759/cureus.26414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 11/15/2022] Open
Abstract
Background During the COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), many patients developed pulmonary barotrauma either self-inflicted or ventilator-induced. In pulmonary barotrauma, air leaks into extra-alveolar tissue resulting in pneumomediastinum, subcutaneous emphysema, pneumothorax, and pneumoperitoneum. Methods After obtaining institutional approval, we retrospectively reviewed data from March 1, 2021, to September 31, 2021. Being a retrospective study, informed consent was not applicable. Patient data were collected from the Al Shifa patient information portal, which is an electronic medical record system available to all hospitals in the Ministry of Health, Oman. After identifying patients with pulmonary barotrauma, the following details were recorded and entered into an Excel sheet (Microsoft Corporation, Albuquerque, New Mexico) and a database was created, which contained the following: age, sex, smoking history, comorbidities, type, location, mode of barotrauma, mode of ventilation, length of intensive care unit (ICU) stay, interventions performed, and overall outcome (survived/deceased). Results A total of 529 patients with COVID-19 pneumonia were admitted from March 2021 to September 2021 to the ICU. Twenty-eight patients developed barotrauma of variable severity and required interventions like the placement of intercostal drains. Out of 28, five patients developed spontaneous barotrauma, 14 patients had barotrauma after initiation of non-invasive ventilation, and nine patients had barotrauma as a result of invasive ventilation. The median number of days in the ICU was 19.5 (interquartile range: 12.5-26.5). Of the 28 patients, eight patients survived and were discharged from the hospital. Conclusion In this single-center, retrospective study at a secondary care hospital in Oman, we described our experience with patients who suffered pulmonary barotrauma during their ICU admission. We have also presented the incidence of spontaneous versus ventilator-induced barotrauma, the length of stay of these patients, the outcomes in terms of survival or death, the need for tracheostomy, secondary infections, and interventions performed as indicated.
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Khan I, Govindu RR, Ammar H. It Is Not a Boerhaave! A Case of Spontaneous Pneumothorax. Cureus 2022; 14:e25191. [PMID: 35746987 PMCID: PMC9208677 DOI: 10.7759/cureus.25191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 11/05/2022] Open
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Elkattawy S, Ayad S, Younes I, Singh Z, Alyacoub R, Brescia ML. COVID-Induced Spontaneous Pneumothoraxes: Case Series. Cureus 2021; 13:e14567. [PMID: 34026383 PMCID: PMC8133774 DOI: 10.7759/cureus.14567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) is a communicable disease leading to COVID-19 infection that resulted in worldwide flooding of medical centers with the shortage of ventilators in some areas. The respiratory system is the most affected by the novel virus. Clinical manifestations are diverse in severity, with the most common symptoms including fever, chills, cough, and shortness of breath. The contributing factor to the morbidity and mortality associated with this virus is the rapid clinical deterioration as a result of a heightened inflammatory response, requiring supplemental oxygen. Pneumothorax is an unusual complication that may further worsen the hypoxia and require immediate intervention. We present a case series of two patients with no risk factors for pneumothorax besides recent COVID-19 infection, who were found to have spontaneous pneumothoraxes.
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Affiliation(s)
- Sherif Elkattawy
- Internal Medicine, Rutgers New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Sarah Ayad
- Internal Medicine, Rutgers New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Islam Younes
- Internal Medicine, Rutgers New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Zamir Singh
- Internal Medicine, St. George's University School of Medicine, Elizabeth, USA
| | - Ramez Alyacoub
- Internal Medicine, Rutgers New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
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Louw EH, Shaw JA, Koegelenberg CFN. New insights into spontaneous pneumothorax: A review. Afr J Thorac Crit Care Med 2021; 27:10.7196/AJTCCM.2021.v27i1.054. [PMID: 34240041 PMCID: PMC8203058 DOI: 10.7196/ajtccm.2021.v27i1.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2020] [Indexed: 11/15/2022] Open
Abstract
A spontaneous pneumothorax is a pneumothorax that does not arise from trauma or an iatrogenic cause. Although the traditional classification of either primary or secondary spontaneous pneumothorax based on the absence or presence of overt underlying lung disease is still widely used, it is now well recognised that primary spontaneous pneumothorax is associated with underlying pleuropulmonary disease. Current evidence indicates that computed tomography screening for underlying disease should be considered in patients who present with spontaneous pneumothorax. Recent evidence suggests that conservative management has similar recurrence rates, less complications and shorter hospital stay compared with invasive interventions, even in large primary spontaneous pneumothoraces of >50%. A more conservative approach which is based on clinical assessment rather than pneumothorax size can thus be followed during the acute management in selected stable patients. The purpose of this review is to revisit the aetiology of spontaneous pneumothorax, identify which patients should be investigated for secondary causes and to give an overview of the management strategies at initial presentation as well as secondary prevention.
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Affiliation(s)
- E H Louw
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - J A Shaw
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - C F N Koegelenberg
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
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Weissman J, Agrawal R. Dramatic complication of pneumothorax treatment requiring lifesaving open-heart surgery. Radiol Case Rep 2021; 16:500-503. [PMID: 33363691 PMCID: PMC7753225 DOI: 10.1016/j.radcr.2020.12.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/25/2022] Open
Abstract
Pneumothorax is an extremely common entity that is typically readily diagnosed and treated. Standard treatment for a small pneumothorax in an otherwise healthy patient is oxygen and observation. For many cases of pneumothorax (those that are larger, more symptomatic, occur in patients with underlying lung disease, or occur in patients who live far from an emergency facility), treatment includes needle aspiration or chest tube placement. We report the clinical presentation and imaging appearance of a 47-year-old female who had a trocar traverse the heart during pleural chest tube placement. Based on this case, policies in the emergency department were reviewed and quality measures were improved.
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Affiliation(s)
- Joshua Weissman
- Northwestern University Feinberg School of Medicine, Department of Radiology, 420 E. Superior St, Chicago, IL 60611 USA
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Spontaneous Pneumothorax: New Horizons. JOURNAL OF RESPIRATION 2021. [DOI: 10.3390/jor1010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Spontaneous pneumothorax can be divided into two categories: primary and secondary. The management of each one depends on resource availability, physician preference, and procedural capability, and is broadly based on guidelines that are over a decade old. Emerging evidence from three recent randomized controlled trials on ambulatory pneumothorax pathways are exciting and herald a new era for management of spontaneous pneumothorax. These three trials and their implications are discussed.
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The association between pneumothorax onset and meteorological parameters and air pollution. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:656-661. [PMID: 33403139 PMCID: PMC7759040 DOI: 10.5606/tgkdc.dergisi.2020.19610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/31/2020] [Indexed: 11/30/2022]
Abstract
Background
The aim of this study was to investigate the possible relation of meteorological parameters and air pollutant particle concentrations with the incidence of spontaneous pneumothorax in the Bolu region of Turkey.
Methods
Between January 2015 and February 2019, a total of 200 patients (175 males, 25 females; mean age 42.5±19.9 years, range, 10 to 88 years) with spontaneous pneumothorax were retrospectively analyzed. For each day, standard weather parameters including daily average temperature, relative humidity, wind speed, actual pressure, and daily total precipitation and concentration of air pollutants (PM10 and SO2) were recorded.
Results
During the study period, there were 200 cases with spontaneous pneumothorax within 178 days. The number of days with spontaneous pneumothorax represented 11.8% of the total number of days (1,504 days). In the study, 76.9% of the days with spontaneous pneumothorax were clustered. All meteorological (temperature, humidity, pressure, wind speed, and precipitation) and air pollution parameters (PM10 a nd SO2) were available for 1,438 days (95.61%) and 853 days (56.71%), respectively. There was a significant relationship between spontaneous pneumothorax and air temperature (r=-0.094, p=0.001), and air pollution (PM10, r=-0.080, p=0.020; SO2, r=-0.067, p=0.045).
Conclusion
Our study results show a relationship between spontaneous pneumothorax and air temperature, and air pollution. Preventing air pollution, which is a public health problem, can lead to a reduction in spontaneous pneumothorax.
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Contralateral Traumatic Hemopneumothorax. Case Rep Emerg Med 2018; 2018:4328704. [PMID: 30729046 PMCID: PMC6313992 DOI: 10.1155/2018/4328704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/26/2018] [Indexed: 12/03/2022] Open
Abstract
Pneumothorax is the entry of air into the virtual space between the visceral and the parietal pleurae, which can occur spontaneously or to a greater extent in a traumatic way. In daily clinical practice it is frequent to find injuries that generate traumatic pneumothorax that is ipsilateral to the lesion. However, there are case reports of contralateral pneumothorax that occurred in procedures such as insertion of pacemakers, or in cases of pneumonectomy. The following is the case report of a 37-year-old man who was admitted with a sharp wound to the right paravertebral region who developed a left haemopneumothorax due to a tangential course of the injuring agent. Adequate clinical judgment was followed, and several imaging studies were carried out, leading to the diagnosis of traumatic pneumothorax that was contralateral to the described injury.
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Orschulik J, Hochhausen N, Czaplik M, Teichmann D, Leonhardt S, Walter M. Addition of internal electrodes is beneficial for focused bioimpedance measurements in the lung. Physiol Meas 2018; 39:035009. [PMID: 29406309 DOI: 10.1088/1361-6579/aaad45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Bioimpedance measurements such as bioimpedance spectroscopy (BIS) or electrical impedance tomography (EIT) are used in many biomedical applications. While BIS measures and analyzes the impedance in a frequency range at constant electrode positions, EIT aims to reconstruct images of the conductivity distribution from multiple measurements at different electrode positions. Our aim is to add spatial information to tetrapolar BIS measurements by using electrode positions that focus measurements on desired regions of interest. In this paper, we aim to investigate, whether internal electrodes that can be integrated into breathing or gastroesophageal tubes, can improve the local sensitivity of bioimpedance spectroscopy measurements. APPROACH We present the results of a simulation study, in which we investigated more than 4 M different electrode configurations on their ability to monitor specific regions of interest (ROI) in the lung. Based on the sensitivity, which describes the impact of a conductivity change on the measured impedance, we define three main criteria which we use to evaluate our simulation results: the selectivity [Formula: see text], which describes the impact of a conductivity change inside the region of interest compared to a conductivity change outside the ROI; the homogeneity [Formula: see text], which describes the distribution of the sensitivity inside the ROI; and the absolute impedance contribution ratio [Formula: see text], which describes the contribution of the ROI to the measured impedance. MAIN RESULTS Depending on the region of interest, electrode configurations using internal electrodes are between 9.8 % and 90 % better with respect to these criteria than configurations using external electrodes only. SIGNIFICANCE The combination of internal and external electrodes improves the focusing ability of tetrapolar impedance measurements on specific lung regions, which may be especially beneficial for lung monitoring in intensive care.
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Affiliation(s)
- Jakob Orschulik
- Philips Chair for Medical Information Technology, Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
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Idris BM, Hefny AF. Large pneumothorax in blunt chest trauma: Is a chest drain always necessary in stable patients? A case report. Int J Surg Case Rep 2016; 24:88-90. [PMID: 27232292 PMCID: PMC4885144 DOI: 10.1016/j.ijscr.2016.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/12/2016] [Accepted: 05/13/2016] [Indexed: 11/23/2022] Open
Abstract
Not all patients with large blunt traumatic pneumothorax need tube thoracostomy. Current recommendations for tube placement in blunt traumatic pneumothorax may needs to be reevaluated. Stable patients with large pneumothorax due to blunt trauma can be treated conservatively.
Introduction Pneumothorax is the most common potentially life-threatening blunt chest injury. The management of pneumothorax depends upon the etiology, its size and hemodynamic stability of the patient. Most clinicians agree that chest drainage is essential for the management of traumatic large pneumothorax. Herein, we present a case of large pneumothorax in blunt chest trauma patient that resolved spontaneously without a chest drain. Presentation of case A 63- year- old man presented to the Emergency Department complaining of left lateral chest pain due to a fall on his chest at home. On examination, he was hemodynamically stable. An urgent chest X-ray showed evidence of left sided pneumothorax. CT scan of the chest showed pneumothorax of more than 30% of the left hemithorax (around 600 ml of air) with multiple left ribs fracture. Patient refused tube thoracostomy and was admitted to surgical department for close observation. The patient was managed conservatively without chest tube insertion. A repeat CT scan of the chest has shown complete resolution of the pneumothorax. Discussion The clinical spectrum of pneumothorax varies from asymptomatic to life threatening tension pneumothorax. In stable patients, conservative management can be safe and effective for small pneumothorax. To the best of our knowledge, this is the second reported case in the English literature with large pneumothorax which resolved spontaneously without chest drain. Conclusion Blunt traumatic large pneumothorax in a clinically stable patient can be managed conservatively. Current recommendations for tube placement may need to be reevaluated. This may reduce morbidity associated with chest tube thoracostomy.
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Affiliation(s)
- Baig M Idris
- Department of Emergency Medicine Al Rahba Hospital, Abu Dhabi, United Arab Emirates
| | - Ashraf F Hefny
- Department of Surgery, Al Rahba Hospital, Abu Dhabi, United Arab Emirates.
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Ng CSH, Wong RHL, Lau RWH, Kwok MWT. Recurrent pneumothorax: the unexpected encounters. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:98. [PMID: 26015940 DOI: 10.3978/j.issn.2305-5839.2015.04.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 04/08/2015] [Indexed: 11/14/2022]
Affiliation(s)
- Calvin S H Ng
- Department of Cardiothoracic Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Randolph H L Wong
- Department of Cardiothoracic Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Rainbow W H Lau
- Department of Cardiothoracic Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Micky W T Kwok
- Department of Cardiothoracic Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
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