Critical Care Self-Study Resources-Pneumothorax in Crit ill Chest 2012

Pneumothorax in Crit ill Chest 2012 - PDF

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Pneumothorax is a condition where air is present in the pleural space, between the lungs and chest wall. It is a common complication in ICU patients, occurring in 4% to 15% of cases. Prompt recognition and intervention are crucial for effective management and prevention of complications. The diagnosis of pneumothorax can be made through physical examination findings or radiographic studies such as chest radiographs, ultrasonography, or CT scanning. Ultrasonography has been emerging as the diagnostic procedure of choice in recent years. It has advantages such as real-time imaging, absence of radiation, and the ability to perform dynamic and repeat evaluations. A study showed that ultrasonography detected 92% of occult pneumothoraces diagnosed with CT scanning. Treatment of pneumothorax involves drainage of the pleural space, and small-bore catheters are now recommended as first-line therapy in ventilated patients. In cases of tension pneumothorax, immediate decompression and drainage should be performed. For patients with persistent air leaks or failure of the lung to expand, surgical consultation should be requested. Bronchoscopic interventions, such as the application of one-way valves, have shown promise in the treatment of prolonged air leaks. However, further research is needed to determine their effectiveness in critically ill patients. Overall, the management of pneumothorax in the critically ill requires a high index of suspicion, prompt recognition, and intervention. Ultrasonography has proven to be a valuable tool in the diagnosis and management of pneumothorax, and small-bore catheters are now preferred for pleural intervention. Surgical consultation should be considered in cases of persistent air leaks.

Keywords

pneumothorax

pleural space

ICU patients

complications

diagnosis

physical examination

radiographic studies

ultrasonography

CT scanning

treatment