Pneumothorax treatment

SuccessM treatment of PEA and asystole depends almost entirely on diagnosis of the underlying cause. Potentially reversible causes include (1) hypovolemia, (2) hypoxia, (3) preexisting acidosis, (4) hyperkalemia, (5) hypothermia, (6) hypoglycemia, (7) drug overdose, (8) cardiac tamponade, (9) tension pneumothorax, (10) coronary thrombosis, (11) pulmonary thrombosis, and (12) trauma. 

Aerosol - Several serious adverse events occurred in severely ill infants with life-threatening underlying diseases, many of whom required assisted ventilation. Additional reports of worsening of respiratory status, bronchospasm, pulmonary edema, hypoventilation, cyanosis, dyspnea, bacterial pneumonia, pneumothorax, apnea, atelectasis, and ventilator dependence have occurred. Sudden deterioration of respiratory function has been associated with initiation of aerosolized ribavirin use in infants. If ribavirin aerosol treatment produces sudden deterioration of respiratory function, stop treatment and reinstitute only with extreme caution, continuous monitoring, and consideration of coadministration of bronchodilators. 

In cases of pneumothorax with closed thoracotomy tube drainage, chronic glucocorticoid treatment has been reported to delay and impede re-expansion of the lung (SED-8, 820). 

An 82-year-old woman was scheduled for gastrectomy with an epidural anesthetic (71). She had previously had many acupuncture treatments with a Japanese technique (okibari), in which small needles are left in situ. Her preoperative chest and abdominal X-rays showed hundreds of needles around the vertebrae. The anesthesiologists feared that an epidural anesthetic might lead to spinal cord injury or pneumothorax, and general anesthesia was chosen instead. 

Injection of ethanol into the liver to treat hepatocellular carcinoma commonly causes severe pain, fever, and hepatic dysfunction there can also be pleural effusion, pneumothorax, ascites, vasovagal reaction, transient hypotension, myoglobinuria, and portal thrombosis. Fatal massive hepatic necrosis distant from the injection site has also been attributed to this treatment (SEDA-18, 377). 

There is an increased incidence of spontaneous pneumothorax after the administration of pentamidine by aerosol, which may be connected with the effect on airway resistance. There was a particularly high frequency of spontaneous pneumothorax in people with hemophilia the authors suggested that P. jiroveci infection and treatment resistance had played a role (SEDA-16, 313). 

Kennedy L, Sahn SA. Talc pleurodesis for the treatment of pneumothorax and pleural effusion. Chest 1994 106(4) 1215-22. 

Lange P, Mortensen J, Groth S. Lung function 22-35 years after treatment of idiopathic spontaneous pneumothorax with talc poudrage or simple drainage. Thorax 1988 43(7) 559-61. 

The drug and nondrug treatments of the most serious of pulmonary complications, including pulmonary hypertension, right-sided heart failure, respiratory failure, pneumothorax, and hemoptysis, are beyond the scope of this chapter. In general, the therapeutic approach does not vary snbstantively from that for other respiratory diseases. 

R.E. (m), with thymine-uraciluria, is the third child of healthy parents. The first child is healthy but the second one died of perinatal asphyxia. A few hours after birth the patient developed cyanosis with a mild respiratory distress. On the third day he developed also a pneumothorax. Furthermore there was a hyperbilirubinemia. Treatment was successful and at 3h weeks he was discharged. Psycho-motor development was normal until the age of Ih years. Then he de/eloped petit mal seizures which were treated. After one month treatment could be discontinued. The parents noticed that behavioural changes occurred after the onset of the seizures. Speech did not develop and his behaviour became solitary. At admission for evaluation of his developmental problems no physical abnormalities were seen. Psychological investigations revealed a normal intelligence with autistic features and the absence of auditory defects. 

In a German observational study of 503 397 treatments documented between July 2001 and June 2003, physicians recorded at least one adverse effect in 7.8% of all patients, the most frequent being needling pain in 3.9% [122. Serious adverse events were reported in 17 cases, the most frequent event being pneumothorax (five cases). 

There are no prospective, randomized studies comparing the various local destruction methods in lung with each other. REA and LITT are the only two really competitive minimally invasive treatment methods, however there are far more data available on lung RFA with LITT restricted to German groups (VoGL et al. 2004). Short-term follow-up seems to be comparable to RFA, in that LITT lesion size is restricted to a maximal diameter of 3 cm however, the pneumothorax rate is much lower with LITT )%) than with RFA (30%-40%). 

Despite case reports of response to treatment with corticosteroids, larger studies have not shown any outcome benefit. Currently, accepted treatment options are limited to supportive care and prevention and treatment of infection. There is a report of three BMT recipients with IPS whose lung function improved following etanercept administration (13). Lung transplant may offer a therapeutic option for selected patients. Although the pneumonitis resolves in about 31%, the clinical course of IPS is often comphcated by viral and fungal infections, pneumothorax, pneumomediastinum, subcutaneous emphysema, pulmonary fibrosis, and autoimmune polyserositis (5). The case fatality of IPS is... 

Central venous catheter placement can be performed in emergency cases that most likely will need immediate and serial dialysis. Risk of bleeding and pneumothorax as well as higher infection rates, shorter service life and often prolonged hemodialysis treatment times have to be taken into account. 

After birth, severe bilateral renal disease can be associated with pneumothorax, lung hypoplasia, and life-threatening respiratory distress (Fig. 13.17) (Perlman et al. 1973). This respiratory failure is an emergency situation, and mechanical respiratory assistance is mandatory even before any treatment can be considered for the urinary tract anomaly. Conversely, whenever a neonate presents seemingly spontaneous pneumothorax, an US examination should be performed in order to verify the status of the urinary tract. 

Fig. 27.6. Axial CT scan of the liver during radiofrequency ablation demonstrates a small pneumothorax that developed following placement of the radiofrequency electrode (arrow). The patient remained asymptomatic during the treatment and no treatment was necessary. In patients with underlying pulmonary disease, even small pneumothoraces can be symptomatic and may require thoracentesis or thoracostomy...

TTiere is a significant risk of tension pneumothorax, and if there is any suspicion of this, immediate needle decompression followed by tube thoracostomy should be carried out. Blood may be aspirated from the bronchial tree during intubation. Lung crepitations may be apparent on auscultation. The treatment for pneumothorax or haemopneumothorax is insertion of a wide-bore intercostal drain in the fifttr intercostal space in the anterior axillary line. Occasionally, local injury will necessitate placement in an alternative location. 

Judson MA, Marshall C, Beale G, Holt JB. Pneumothorax and bronchopleural fistula during treatment of allergic bronchopulmonary aspergillosis. South Med J 1993 86 1061-1063. 

---