SECONDARY SPONTANEOUS PNEUMOTHORAX IN A PATIENT WITH SARCOIDOSIS TREATED WITH ENDOBRONCHIAL VALVE

BACKGROUNDThere is no technique in general use that reliably predicts the outcome of manual aspiration of spontaneous pneumothorax. We have hypothesised that the absence of a pleural leak at the time of aspiration will identify a group of patients in whom immediate discharge is unlikely to be complicated by early lung re-collapse and have tested this hypothesis by using a simple bedside tracer gas technique.METHODSEighty four episodes of primary spontaneous pneumothorax and 35 episodes of secondary spontaneous pneumothorax were studied prospectively. Patients breathed air containing a tracer (propellant gas from a pressurised metered dose inhaler) while the pneumothorax was aspirated percutaneously. Tracer gas in the aspirate was detected at the bedside using a portable flame ioniser and episodes were categorised as tracer gas positive (>1 part per million of tracer gas) or negative. The presence of tracer gas was taken to imply a persistent pleural leak. Failure of manual aspiration and the need for a further intervention was based on chest radiographic appearances showing either failure of the lung to re-expand or re-collapse following initial re-expansion.RESULTSA negative tracer gas test alone implied that manual aspiration would be successful in the treatment of 93% of episodes of primary spontaneous pneumothorax (p<0.001) and in 86% of episodes of secondary spontaneous pneumothorax (p=0.01). A positive test implied that manual aspiration would either fail to re-expand the lung or that early re-collapse would occur despite initial re-expansion in 66% of episodes of primary spontaneous pneumothorax and 71% of episodes of secondary spontaneous pneumothorax. Lung re-inflation on the chest radiograph taken immediately after aspiration was a poor predictor of successful aspiration, with lung re-collapse occurring in 34% of episodes by the following day such that a further intervention was required.CONCLUSIONSNational guidelines currently recommend immediate discharge of patients with primary spontaneous pneumothorax based primarily on the outcome of the post-aspiration chest radiograph which we have shown to be a poor predictor of early lung re-collapse. Using a simple bedside test in combination with the post-aspiration chest radiograph, we can predict with high accuracy the success of aspiration in achieving sustained lung re-inflation, thereby identifying patients with primary spontaneous pneumothorax who can be safely and immediately discharged home and those who should be observed overnight because of a significant risk of re-collapse, with an estimated re-admission rate of 1%.

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Surgical treatment for secondary spontaneous pneumothorax: a risk factor analysis

Surgery Today ◽

10.1007/s00595-020-02206-0 ◽

2021 ◽

Author(s):

Norikazu Kawai ◽

Takeshi Kawaguchi ◽

Motoaki Yasukawa ◽

Takashi Tojo ◽

Noriyoshi Sawabata ◽

...

Keyword(s):

Factor Analysis ◽

Risk Factor ◽

Surgical Treatment ◽

Spontaneous Pneumothorax ◽

Risk Factor Analysis ◽

Secondary Spontaneous Pneumothorax

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Comparison of video-assisted thoracoscopic talcage for recurrent primary versus persistent secondary spontaneous pneumothorax

CrossRef Listing of Deleted DOIs ◽

10.1183/09031936.97.10020412 ◽

1997 ◽

Vol 10 (2) ◽

pp. 412-416 ◽

Cited By ~ 25

Author(s):

M. Noppen ◽

M. Meysman ◽

J. d'Haese ◽

I. Monsieur ◽

W. Verhaeghe ◽

...

Keyword(s):

Spontaneous Pneumothorax ◽

Secondary Spontaneous Pneumothorax ◽

Video Assisted

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Pleurodesis After Bronchial Occlusion for Inoperable Secondary Spontaneous Pneumothorax

Journal of Bronchology & Interventional Pulmonology ◽

10.1097/lbr.0000000000000785 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Hirotaka Kida ◽

Hiromi Muraoka ◽

Kei Morikawa ◽

Takeo Inoue ◽

Masamichi Mineshita

Keyword(s):

Spontaneous Pneumothorax ◽

Secondary Spontaneous Pneumothorax

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The efficacy and economical benefits of blood patch pleurodesis in secondary spontaneous pneumothorax patients

Polish Journal of Cardio-Thoracic Surgery ◽

10.5114/kitp.2016.58960 ◽

2016 ◽

Vol 1 ◽

pp. 21-25 ◽

Cited By ~ 4

Author(s):

Serdar Evman ◽

Levent Alpay ◽

Serda Metin ◽

Hakan Kıral ◽

Mine Demir ◽

...

Keyword(s):

Spontaneous Pneumothorax ◽

Secondary Spontaneous Pneumothorax ◽

Blood Patch

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Secondary spontaneous pneumothorax complicating miliary tuberculosis in a young woman

BMJ Case Reports ◽

10.1136/bcr-2013-201109 ◽

2014 ◽

Vol 2014 (jan30 1) ◽

pp. bcr2013201109-bcr2013201109 ◽

Cited By ~ 1

Author(s):

A. S. Singh ◽

V. Atam ◽

L. Das

Keyword(s):

Young Woman ◽

Spontaneous Pneumothorax ◽

Miliary Tuberculosis ◽

Secondary Spontaneous Pneumothorax

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RISK FACTORS FOR MORBIDITY AND MORTALITY AFTER SURGERY FOR SECONDARY SPONTANEOUS PNEUMOTHORAX DUE TO COPD

CHEST Journal ◽

10.1016/j.chest.2018.08.033 ◽

2018 ◽

Vol 154 (4) ◽

pp. 35A

Author(s):

ROLAND WEIXIANG XU ◽

ANEEZ AHMED ◽

ATASHA ASMAT

Keyword(s):

Risk Factors ◽

Spontaneous Pneumothorax ◽

Morbidity And Mortality ◽

Secondary Spontaneous Pneumothorax

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Clinical and aetiological spectrum of spontaneous pneumothorax in adults in Sub-Himalayan: a prospective study at tertiary care institute

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20180393 ◽

2018 ◽

Vol 4 (2) ◽

pp. 22

Author(s):

Ajay Sharma ◽

Ashok Sharma ◽

Pramod Jaret ◽

Malay Sarkar ◽

Sanjeev Sharma

Keyword(s):

Pulmonary Tuberculosis ◽

Prospective Study ◽

Spontaneous Pneumothorax ◽

Tertiary Care ◽

Primary Spontaneous Pneumothorax ◽

Age Group ◽

Outcome Indicators ◽

Secondary Spontaneous Pneumothorax ◽

A Prospective Study ◽

Aetiological Spectrum

Background: The spontaneous pneumothorax has been classified as major cause of morbidity and mortality among respiratory diseases. The objectives of the study were to determine the incidence and aetiology of spontaneous pneumothorax and to assess the clinical profile of affected patients admitted in our institute.Methods: A hospital based prospective study was conducted in year 2011-12 in the Department of Medicine, IGMC Shimla (H.P.) India. During study period the total admissions were 7335 out of which 30 patients were diagnosed as spontaneous pneumothorax and treated as cases under study. The data was collected on proforma includes demographic profile, probable cause, clinical and outcome indicators of Spontaneous Pneumothorax, master chart framed and analysed into frequency percentage. Results: Incidence of spontaneous pneumothorax was found to be 408.99/yr/100000 admissions in the department of medicine. Incidence of primary spontaneous pneumothorax was 81.79/yr/100000 admissions. Incidence of secondary spontaneous pneumothorax was 327.19/yr/100000 admissions. Majority of the patients of primary spontaneous pneumothorax were of the 20-29yrs age group. Higher proportions of cases were from male gender (93.33%). Secondary pneumothorax patients were mostly of 50 to 59 years age group. The predominant aetiology for secondary spontaneous pneumothorax was COPD (36.66%) followed by Pulmonary tuberculosis (33.33%).Conclusions: Spontaneous pneumothorax was more common in men. The predominant aetiology for secondary spontaneous pneumothorax was COPD (36.66%) followed by pulmonary tuberculosis (33.33%).

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An air-locking port and high-flow nasal cannula in non-intubated uniportal video-assisted thoracic surgery for pneumothorax with pulmonary dysfunction: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01321-5 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Hiroya Yamagishi ◽

Yusuke Wakatsuki ◽

Toshihiko Tada ◽

Tadashi Matsukura

Keyword(s):

Thoracic Surgery ◽

Flow Rate ◽

Spontaneous Pneumothorax ◽

High Flow ◽

Nasal Cannula ◽

High Flow Rate ◽

High Flow Nasal Cannula ◽

Video Assisted Thoracic Surgery ◽

Secondary Spontaneous Pneumothorax ◽

Video Assisted

Abstract Background Non-intubated video-assisted thoracic surgery is a therapeutic option for intractable secondary spontaneous pneumothorax in patients who are poor candidates for surgery with endotracheal intubation under general anesthesia. However, intraoperative respiratory management in this surgery is often challenging because of hypoxia caused by surgical pneumothorax. Case presentation A 75-year-old man with idiopathic pulmonary fibrosis who had been on home oxygen therapy underwent non-intubated uniportal video-assisted thoracic surgery for intractable spontaneous pneumothorax. During the operation, oxygen was administered using a high-flow nasal cannula at a high flow rate. An air-locking port for single-incision surgery was used to minimize the inflow of air into the pleural cavity. The intrapleural air was continuously suctioned through the chest tube. The air-leak point was easily identified and closed using ligation. Oxygenation was satisfactory throughout the operation. Conclusions Non-intubated uniportal video-assisted thoracic surgery for secondary spontaneous pneumothorax with an air-locking port, continuous pleural suction, and high-flow nasal cannula may achieve satisfactory intraoperative oxygenation in patients with respiratory dysfunction. The intrapleural space can be feasible for surgical manipulation without surgical pneumothorax in non-intubated video-assisted thoracic surgery even when supplied with oxygen at a high flow rate using a high-flow nasal cannula.

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