Case Report

Large Pneumothorax Associated with Mechanical Ventilation in Patients with Chronic Respiratory Disease

Abstract

Difficult intubation and mechanical ventilation are common causes of pneumothorax in critically ill patients. Patients with chronic respiratory tract disease are at high risk for pneumothorax caused by positive-pressure mechanical ventilation. A timely diagnosis of pneumothorax is critical as it may evolve into tension pneumothorax. In this case report, we report a patient who has a decreased level of consciousness due to opioid overdose. In the emergency room, she underwent mechanical ventilation and became conscious after a naloxone injection. After extubation, she has extensive subcutaneous emphysema. However, her hemodynamic and respiratory status is normal. The chest CT scan showed a large pneumothorax caused by mechanical ventilation.

[1] Hsu CW, Sun SF. Iatrogenic pneumothorax related to mechanical ventilation. World J Crit Care Med. 2014; 3(1):8-14.
[2] de Lassence A, Timsit J-F, Tafflet M, Azoulay É, Jamali S, Vincent F, et al. Pneumothorax in the Intensive Care Unit: Incidence, Risk Factors, and Outcome. Anesthesiology. 2006; 104(1):5-13.
[3] Thachuthara-George J. Pneumothorax in patients with respiratory failure in ICU. J Thorac Dis. 2021; 13(8):5195-204.
[4] Rankine JJ, Thomas AN, Fluechter D. Diagnosis of pneumothorax in critically ill adults. Postgrad Med J. 2000; 76(897):399-404.
[5] Roberts DJ, Leigh-Smith S, Faris PD, Blackmore C, Ball CG, Robertson HL, et al. Clinical Presentation of Patients With Tension Pneumothorax: A Systematic Review. Annals of Surgery. 2015; 261(6):1068-78.
[6] Rastegari H, Heidari M, Keykha A. Traumatic Tension Pneumothorax with Extensive Subcutaneous Emphysema. Arch Anesthesiol Crit Care. 2024;
[7] Akdogan RE, Mohammed T, Syeda A, Jiwa N, Ibrahim O, Mutneja R. Pneumothorax in Mechanically Ventilated Patients with COVID-19 Infection. Case Rep Crit Care. 2021; 2021(1) 6657533.
[8] Mayahara T, Katayama T, Higashi Y, Asano J, Sugimoto T. Position-Dependent Symptoms of Pneumothorax During Mechanical Ventilation: A Case Report. Cureus. 2023; 15(12):e50820.
[9] Ali AA, El Wahsh RA, Agha MA, Tawadroos BB. Pressure regulated volume controlled ventilation versus synchronized intermittent mandatory ventilation in COPD patients suffering from acute respiratory failure. Egypt J Chest Dis Tuberc. 2016; 65(1):121-5.
[10] Ioannidis G, Lazaridis G, Baka S, Mpoukovinas I, Karavasilis V, Lampaki S, et al. Barotrauma and pneumothorax. J Thorac Dis. 2015; 7(Suppl 1):S38-43.
[11] Diaz R, Heller D. Barotrauma and Mechanical Ventilation: StatPearls Publishing, Treasure Island (FL); 2023.
[12] Boussarsar M, Thierry G, Jaber S, Roudot-Thoraval F, Lemaire F, Brochard L. Relationship between ventilatory settings and barotrauma in the acute respiratory distress syndrome. Intensive Care Med. 2002; 28(4):406-13.
[13] Anzueto A, Frutos-Vivar F, Esteban A, Alía I, Brochard L, Stewart T, et al. Incidence, risk factors and outcome of barotrauma in mechanically ventilated patients. Intensive Care Med. 2004; 30(4):612-9.
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Keywords
Pneumothorax Related to Mechanical Ventilation Mechanical Ventilation Pneumothorax Tension Pneumothorax Respiratory Tract Disease

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How to Cite
1.
Rahat Dahmardeh A, Keykha A. Large Pneumothorax Associated with Mechanical Ventilation in Patients with Chronic Respiratory Disease. Arch Anesth & Crit Care. 2024;.