Journal articles: 'Open pneumothorax'

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Ma, Hui, Wei Jia, and Yuechuan Li. "Analyzing thoracic cavity gas during pneumothorax treatment to monitor the pneumothorax conditions in real time for updating the treatment strategy: A pilot study." TECHNOLOGY 03, no. 04 (December 2015): 189–93. http://dx.doi.org/10.1142/s2339547815500077.

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ObjectivesTo monitor the pneumothorax conditions in real time by analyzing thoracic cavity gas during pneumothorax treatment, and provide instructions for updating the treatment strategy.MethodsThe partial pressures of O2and CO2in the thoracic cavity from 49 pneumothorax patients was analyzed before the management and after chest tube clogging during the management. The pneumothorax type was differentially diagnosed according to the partial pressure results, and the treatment strategy was updated accordingly.ResultsThe 49 pneumothorax patients were divided into four groups, as follows: Group A, 30 patients with a closed pneumothorax were confirmed to have a closed pneumothorax in the second analysis; Group B, 10 patients with an open pneumothorax were confirmed to have an open pneumothorax in the second analysis; Group C, three patients with a tension pneumothorax confirmed to have a tension pneumothorax in the second analysis; and Group D, six patients with a closed pneumothorax were re-diagnosed to have an open pneumothorax in the second analysis. The cure rates of the four groups after treatment were as follows: Group A (97%, 29/30), Group B (100%, 16/16), Group C (100%, 3/3) and Group D (100%, 6/6).ConclusionsAnalyzing thoracic cavity gas during pneumothorax treatment is suggested as an efficient way to monitor the pneumothorax conditions in real time and to provide instructions for updating the treatment strategy.

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Canola, Paulo A., Carlos A. A. Valadão, Júlio C. Canola, Fabíola N. Flôres, and Maristela C. S. Lopes. "Experimentally Induced Open Pneumothorax in Horses." Journal of Equine Veterinary Science 80 (September 2019): 90–97. http://dx.doi.org/10.1016/j.jevs.2019.06.011.

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Bisenkov, L. N., D. V. Gladyshev, V. V. Lishenko, and A. P. Chuprina. "Thoracoscopy in treatment of bullous lung disease complicated by pneumothorax." PULMONOLOGIYA, no. 1 (February 28, 2005): 29–33. http://dx.doi.org/10.18093/0869-0189-2005-0-1-29-33.

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The authors’ treatment experience of 292 patients with spontaneous pneumothorax is presented. Results of the pleural drainage (188 patients), thoracoscopy and talc pleurodesis (43 patients), videothoracoscopic surgical treatment (61 patients) are discussed. Recurrent pneumothorax after videothoracoscopic treatment was in 1 case only and only 1 patient needed in open thoracotomy (p < 0.05). Videothoracoscopy is an accurate, safe, and reliable alternative for open thoracotomy and conservative treatment in the management of patients with spontaneous pneumothorax.

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McClintick, Colleen M. "Open Pneumothorax Resulting From Blunt Thoracic Trauma." Journal of Trauma Nursing 15, no. 2 (April 2008): 72–76. http://dx.doi.org/10.1097/01.jtn.0000327332.69814.b9.

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Klaiber, Ulla, Pascal Probst, Matthes Hackbusch, Katrin Jensen, Colette Dörr-Harim, Felix J. Hüttner, Thilo Hackert, Markus K. Diener, Markus W. Büchler, and Phillip Knebel. "Meta-analysis of primary open versus closed cannulation strategy for totally implantable venous access port implantation." Langenbeck's Archives of Surgery 406, no. 3 (January 9, 2021): 587–96. http://dx.doi.org/10.1007/s00423-020-02057-w.

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Abstract Background There is still no reference standard for the implantation of totally implantable venous access ports (TIVAPs). A recently published multicentre randomised controlled trial (RCT) revealed a significantly greater risk of pneumothorax after closed cannulation than after an open strategy. The aim of this meta-analysis was to provide an update of the available evidence for the safety and effectiveness of primary open versus closed cannulation strategy. Methods RCTs comparing outcomes of open cut-down of the cephalic vein and closed cannulation of the subclavian vein were sought systematically in MEDLINE, Web of Science and CENTRAL. The primary outcome was the occurrence of pneumothorax. A beta-binominal model was applied to combine the respective outcomes, and results are presented as odds ratios (OR) with 95% confidence interval (CI). Results Six RCTs with a total of 1831 patients were included in final analysis. Meta-analysis showed statistically significant superiority of the open cut-down technique regarding pneumothorax (OR 0.308, 95% CI 0.122 to 0.776), but a statistically significant higher failure of the primary technique for the open cut-down technique than for closed cannulation (OR 2.364, 95% CI 1.051 to 5.315). There were no significant differences between the two procedures regarding other morbidity endpoints. Conclusion This meta-analysis shows a general superiority of open cut-down of the cephalic vein over closed cannulation of the subclavian vein regarding the occurrence of pneumothorax. Open cut-down should be the first-line approach for TIVAP implantation. Closed cannulation should be performed with ultrasound as second-line procedure if the open technique fails. Systematic review registration PROSPERO CRD42013005180

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Abdullah, Al Qudah. "Video-assisted thoracoscopy versus open thoracotomy for spontaneous pneumothorax." Journal of Korean Medical Science 14, no. 2 (1999): 147. http://dx.doi.org/10.3346/jkms.1999.14.2.147.

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Nazari, Stefano, Paolo Buniva, Alessandro Aluffi, and Susanna Salvi. "Bilateral open treatment of spontaneous pneumothorax: a new access✩." European Journal of Cardio-Thoracic Surgery 18, no. 5 (November 2000): 608–10. http://dx.doi.org/10.1016/s1010-7940(00)00566-2.

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Karapolat, Sami, Alaaddin Buran, and Atila Turkyilmaz. "Bilateral open pneumothorax resulting in a sucking chest wound." Acta Chirurgica Belgica 118, no. 5 (July 16, 2018): 336–37. http://dx.doi.org/10.1080/00015458.2018.1493819.

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Lippi, Donatella, Antonio Perciaccante, Victor Asensi, Philippe Charlier, Otto Appenzeller, and Raffaella Bianucci. "Open Tension Pneumothorax in “The Dying Niobid” (Uffizi Gallery)." Chest 155, no. 4 (April 2019): 878–80. http://dx.doi.org/10.1016/j.chest.2018.12.028.

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Taira, Yasuhiko, Hiroaki Osada, Kumio Yokote, Sumiho Kurisu, Noboru Yamate, Sinichi Kakimoto, and Takasi Miyake. "Lymphangiomyomatosis with pneumothorax after open lung biopsy; a case report." Journal of the Japanese Association for Chest Surgery 6, no. 2 (1992): 159–65. http://dx.doi.org/10.2995/jacsurg1987.6.159.

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Curpod, PrasadG, Govindswamy Suresh, ThaggikuppeV Giri, and SyedaG Azha. "Surgical emphysema and pneumothorax following open cholecystectomy under general anesthesia." Ain-Shams Journal of Anaesthesiology 7, no. 3 (2014): 465. http://dx.doi.org/10.4103/1687-7934.139598.

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Weissman, Joshua, and Rajneesh Agrawal. "Dramatic complication of pneumothorax treatment requiring lifesaving open-heart surgery." Radiology Case Reports 16, no. 3 (March 2021): 500–503. http://dx.doi.org/10.1016/j.radcr.2020.12.034.

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Phillips, S., and G. L. Falk. "Surgical Tension Pneumothorax during Laparoscopic Repair of Massive Hiatus Hernia: A Different Situation Requiring Different Management." Anaesthesia and Intensive Care 39, no. 6 (November 2011): 1120–23. http://dx.doi.org/10.1177/0310057x1103900621.

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During laparoscopic repair of massive hiatus hernia, surgical dissection can breach the parietal pleura allowing insufflating carbon dioxide to rapidly expand the pleural space, causing a tension pneumothorax. This extrapulmonary pneumothorax involves no damage to the lung parenchyma. Its rapid resolution is aided by the high solubility of carbon dioxide and it will not refill once the procedure is completed. In this series of 50 massive hiatus hernia repairs the incidence of pneumothorax was 22% (11/50), with two of these being bilateral. Cardiovascular compromise occurred in 91% of those (10/11). The aetiology, pathophysiology and management of this intraoperative capnothorax differ significantly from that of a pneumothorax secondary to lung trauma or occurring during other types of laparoscopy. Understanding the relevant pleural anatomy and pathophysiology of this condition allowed conservative management in all cases and avoided the need for chest drains, open surgery or abandonment of the procedure.

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Islam, Md Mahmudul, Khondkar A. K. Azad, Md Aminul Islam, and Rivu Raj Chakraborty. "Chest Trauma Evaluation and Outcome of Management in a Tertiary Hospital-One Year Experience." Journal of Surgical Sciences 23, no. 1 (March 22, 2020): 19–24. http://dx.doi.org/10.3329/jss.v23i1.44240.

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Background: Chest trauma is responsible for 50% of deaths due to trauma. This kind of death usually occurs immediately after trauma. Various therapeutic options have been reported for management of chest injuries like clinical observation, thoracocentesis, tube thoracostomy and open thoracotomy. Methods: This is an observational study carried out in the department of Casualty, Chittagong Medical College Hospital over a period of one year (from April 2015 to March 2016). All the patients (both male and female) admitted in the casualty units within the specified period were included in this study. Result: The mean age was found 37.7±18.1 years and male-female ratio was 11.8:1. Almost one third (35.7%) patients were affected by road traffic accident. 42(27.2%) patients were found open pneumothorax followed by rib fracture-41(26.6%), haemopneumothorax-31(20.1%), pneumothorax- 14(9%), haemothorax-12(7.8%), chest wall injury-6(3.9%), tension pneumothorax-5(3.2%), and flail chest-3(1.9%). More than three fourth (80.5%) patients were managed by tube thoracostomy followed by 28(18.2%) observation and 2(1.3%) ventilatory support. No thoracotomy was done in emergency department. Re-insertion of ICT was done in 6(4.7%) patients. More than two third (68.2%) patients recovered well, 43(27.9%) patients developed complications and 6(3.9%) patients died. Conclusion: Most of the patients were in 3rd decade with male predominance. Road traffic accident was the commonest cause and open pneumothorax was the commonest chest trauma. Three-fourths were managed by tube thoracostomy. Nearly one third of the patients had developed complications and about four percent of patients died. Journal of Surgical Sciences (2019) Vol. 23 (1) : 19-24

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Zhang, Jinzhu, Kan Xu, Xuan Chen, Bin Qi, Kun Hou, and Jinlu Yu. "Immediate pneumothorax after neurosurgical procedures." Journal of International Medical Research 48, no. 12 (December 2020): 030006052097649. http://dx.doi.org/10.1177/0300060520976496.

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Objective Pneumothorax after neurosurgical procedures is very rare and incompletely understood. This study was performed to explore the clinical characteristics and pathogenesis of pneumothorax after neurosurgery. Methods We retrospectively evaluated patients admitted from December 2016 to April 2019 for treatment of spontaneous intracranial hemorrhage. The inclusion criteria were neurosurgical procedures (open surgeries or endovascular intervention) performed under general anesthesia, no performance of central venous puncture during surgery, and occurrence of pneumothorax immediately after the neurosurgical procedure. Results Eight patients developed pneumothorax after neurosurgical procedures for spontaneous intracranial hemorrhage under general anesthesia. Of the eight patients, seven had aneurysmal subarachnoid hemorrhage and one had left temporal–parietal hemorrhage. The lung injury prediction score (LIPS) was 3, 4, 5, 6, and 9.5 in three, one, two, one, and one patient, respectively. During the operation, volume-controlled ventilation (tidal volume, 8–10 mL/kg) was selected for all patients. Conclusions Neurogenic pulmonary edema, inappropriate mechanical ventilation, and stimulation by endotracheal intubation might conjointly contribute to postoperative pneumothorax. To avoid this rare entity, mechanical ventilation with a low tidal volume or low pressure during general anesthesia should be adopted for patients with hemorrhagic cerebrovascular diseases involving the temporal lobe and a LIPS of >3.

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Leech, Caroline, Keith Porter, Richard Steyn, Colville Laird, Imogen Virgo, Richard Bowman, and David Cooper. "The pre-hospital management of life-threatening chest injuries: A consensus statement from the Faculty of Pre-Hospital Care, Royal College of Surgeons of Edinburgh." Trauma 19, no. 1 (September 22, 2016): 54–62. http://dx.doi.org/10.1177/1460408616664553.

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‘The pre-hospital management of chest injury: a consensus statement’ was originally published by the Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh in 2007. To update the pre-existing guideline, a consensus meeting of stakeholders was held by the Faculty of Pre-hospital Care in Coventry in November 2013. This paper provides a guideline for the pre-hospital management of patients with the life-threatening chest injuries of tension pneumothorax, open pneumothorax, massive haemothorax, flail chest (including multiple rib fractures), and cardiac tamponade.

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Schlossberg, Matt, Patrick Ross, and Mark A. Gerhardt. "Open Chest Tension Pneumothorax during Lung Volume Reduction Surgery via Sternotomy." Anesthesiology 98, no. 1 (January 1, 2003): 272–74. http://dx.doi.org/10.1097/00000542-200301000-00043.

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Joshi, V., B. Kirmani, and J. Zacharias. "Thoracotomy versus VATS: is there an optimal approach to treating pneumothorax?" Annals of The Royal College of Surgeons of England 95, no. 1 (January 2013): 61–64. http://dx.doi.org/10.1308/003588413x13511609956138.

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Introduction The 2010 British Thoracic Society guidelines recommend that a weighted decision be made by clinicians with regard to surgical intervention for pneumothorax as the video assisted thoracoscopic surgery (VATS) approach is better tolerated by patients but carries a higher rate of recurrence (5% vs 1%). Methods Overall, 163 patients underwent surgical intervention for pneumothorax at our institution and data were collected prospectively for almost 7 years. Of these, 86 patients underwent VATS under a single surgeon with extensive VATS experience to compensate for the associated learning curve while 79 patients underwent an open procedure. Results There was no statistically significant difference in the recurrence rate between the open and the VATS group (1% vs 3.5%, p=1.0). The VATS group was superior to the open group in terms of reduced postoperative bleeding (7.5% vs 0%, p=0.01), reduced number of intensive care unit admissions (16% vs 0%, p<0.01) and a reduced adjusted length of stay (3 vs 5.5 days, p<0.01). Conclusions A comparable recurrence rate is attainable with a VATS approach once the learning curve is surpassed and a reduction in morbidity is an additional merit.

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Fatimi, Saulat H., Nida Sajjad, Marium Muzaffar, and Hashim M. Hanif. "Ruptured hydatid cyst presenting as pneumothorax." Journal of Infection in Developing Countries 4, no. 04 (January 4, 2010): 256–58. http://dx.doi.org/10.3855/jidc.538.

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Patients with echinococcus infection are mostly asymptomatic. The documented rates of simple pneumothorax in patients with pulmonary hydatidosis ranged from 2.4% - 6.2%. We report a case of a forty-year-old male patient who was referred to our hospital for management of recurrent pneumothorax. A video assisted thoracoscope (VATS) was first introduced which showed a large amount of pus in the pleural cavity and a perforated hydatid cyst. The VATS was converted to an open thoracotomy and decortication was done with removal of the ruptured hydatid. The patient made an unremarkable recovery and was discharged after one week with empyema tubes. The empyema tubes were gradually removed over a period of six weeks. An extraordinary number of management options for pulmonary hydatid disease have been offered. This case report highlights surgical treatment as the management opti

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Spiro, Judith E., Snezana Sisovic, Ben Ockert, Wolfgang Böcker, and Georg Siebenbürger. "Secondary tension pneumothorax in a COVID-19 pneumonia patient: a case report." Infection 48, no. 6 (June 18, 2020): 941–44. http://dx.doi.org/10.1007/s15010-020-01457-w.

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Abstract Purpose Especially in elderly and multimorbid patients, Coronavirus Disease 2019 (COVID-19) may result in severe pneumonia and secondary complications. Recent studies showed pneumothorax in rare cases, but tension pneumothorax has only been reported once. Case presentation A 47-year-old male was admitted to the emergency department with fever, dry cough and sore throat for the last 14 days as well as acute stenocardia and shortage of breath. Sputum testing (polymerase chain reaction, PCR) confirmed SARS-CoV-2 infection. Initial computed tomography (CT) showed bipulmonary groundglass opacities and consolidations with peripheral distribution. Hospitalization with supportive therapy (azithromycin) as well as non-invasive oxygenation led to a stabilization of the patient. After 5 days, sputum testing was negative and IgA/IgG antibody titres were positive for SARS-CoV-2. The patient was discharged after 7 days. On the 11th day, the patient realized pronounced dyspnoea after coughing and presented to the emergency department again. CT showed a right-sided tension pneumothorax, which was relieved by a chest drain (Buelau) via mini open thoracotomy. Negative pressure therapy resulted in regression of the pneumothorax and the patient was discharged after 9 days of treatment. Conclusion Treating physicians should be aware that COVID-19 patients might develop severe secondary pulmonary complications such as acute tension pneumothorax. Level of evidence V

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Mukku, Venkata Kishore, Emily Cassidy, Catalina Negulescu, Tonya Jagneaux, and John Godke. "Large Spontaneous Right Catamenial Pneumothorax with Diaphragmatic Defect and Liver Herniation." Case Reports in Pulmonology 2019 (May 27, 2019): 1–4. http://dx.doi.org/10.1155/2019/8436450.

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Catamenial pneumothorax is a spontaneous pneumothorax that occurs predominantly women of child bearing age. We describe a case of a 40-year-old nulliparous woman with medical history significant for endometriosis who presented with severe chest tightness of one-day duration. Chest radiography (CXR) showed a large right spontaneous pneumothorax, what was thought to be a 5.6 cm pleural mass at the right lung base. Following pneumothorax diagnosis, the patient underwent emergent right thoracostomy with pigtail catheter placement. A repeat CXR revealed marked re-expansion of the lung but persistence of a right pleural mass. Follow up computed tomography scan of the chest showed a 33 mm diaphragmatic defect with 5.8 x 4.6 x 3.9 cm area of herniated liver corresponding to the presumed pleural mass. Following complete thoracic imaging, patient underwent video-assisted thoracoscopic surgery, mechanical pleurodesis, and open repair of the right diaphragmatic defect. Intraoperatively, an endometrial implant was noted on the chest wall. On postoperative day three, she began her menstrual cycle and was evaluated by gynecologist who recommended hormonal therapy to reduce risk of recurrent pneumothorax. Due to a persistent air leak, the chest tube was transitioned to a Heimlich valve to facilitate home discharge. The patient was discharged on postoperative day eight, seen as outpatient with resolution of air leak and removal of chest tube.

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Hallifax, Rob J., Edward McKeown, Parthipan Sivakumar, Ian Fairbairn, Christy Peter, Andrew Leitch, Matthew Knight, et al. "Ambulatory management of primary spontaneous pneumothorax: an open-label, randomised controlled trial." Lancet 396, no. 10243 (July 2020): 39–49. http://dx.doi.org/10.1016/s0140-6736(20)31043-6.

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Esposito, Rick A., Arthur Boyd, and Frank C. Spencer. "The Value of Computed Tomography in Postoperative Pneumothorax Following Open-Heart Surgery." Annals of Thoracic Surgery 42, no. 6 (December 1986): 699–701. http://dx.doi.org/10.1016/s0003-4975(10)64614-0.

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Gupta, Pooja, and Ariel Modrykamien. "Fatal Case of Tension Pneumothorax and Subcutaneous Emphysema After Open Surgical Tracheostomy." Journal of Intensive Care Medicine 29, no. 5 (May 3, 2013): 298–301. http://dx.doi.org/10.1177/0885066613486739.

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Bartholomew, Seth, and Amanda Young. "Ambulatory management of primary spontaneous pneumothorax: an open label randomized controlled trial." Journal of Emergency Medicine 59, no. 4 (October 2020): 627–28. http://dx.doi.org/10.1016/j.jemermed.2020.09.007.

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König, Tatjana Tamara, Eva Wittenmeier, and Oliver J. Muensterer. "Emergency Repair of an Isolated Traumatic Avulsion of the Right Main Stem Bronchus in a 7-Year-Old Girl." European Journal of Pediatric Surgery Reports 07, no. 01 (January 2019): e1-e4. http://dx.doi.org/10.1055/s-0039-1681038.

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Introduction Isolated tracheobronchial injury after blunt trauma of the chest is rare. Because of the high elasticity of the chest in children, they occur mainly in the pediatric population. Case Report We report a case of a 7-year-old girl who experienced complete avulsion of the right main bronchus at the level of the carina after a horse-riding accident. The patient presented with extensive emphysema of the upper chest, neck, and face and severe respiratory distress. Endotracheal intubation led to tension pneumothorax. After insertion of two 17-mm thoracostomy tubes, pneumothorax and a massive air leak persisted. Isolated central bronchial injury was confirmed by computed tomography of the chest. Bronchoscopically guided selective intubation of the left main stem bronchus failed and the patient desaturated, requiring immediate salvage right posterolateral thoracotomy. Simultaneous occlusion of the defect, stabilization, and subsequent selective left lung intubation was possible only after placing a suture at the tracheal rim of the defect for retraction allowing compression of the defect and keeping the lumen open at the same time. Conclusion A cluster of clinical signs with subcutaneous emphysema and refractory pneumothorax with air leak of the thoracotomy tube is indicative of bronchial injury. Endotracheal intubation should be postponed in these cases until after thoracostomy tube placement, if possible. Placing a retraction suture during repair is a maneuver that helps to occlude the defect and keep the remaining tracheobronchial lumen open at the same time to establish crucial ventilation of the contralateral lung.

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Amaniti, Ekaterini, Chrysoula Provitsaki, Panagiota Papakonstantinou, George Tagarakis, Konstantinos Sapalidis, Ioannis Dalakakis, Dimitrios Gkinas, and Vasilios Grosomanidis. "Unexpected Tension Pneumothorax-Hemothorax during Induction of General Anaesthesia." Case Reports in Anesthesiology 2019 (February 24, 2019): 1–4. http://dx.doi.org/10.1155/2019/5017082.

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Tension pneumothorax during general anaesthesia is a rare but possibly deleterious event, especially where predisposing factors are absent or unknown, making diagnosis even challenging. We describe a case of a healthy middle-aged woman, who was planned to receive general anaesthesia for total thyroidectomy. After intubation, the patient experienced marked hypoxemia (SpO2=75%), hypotension, and tachycardia. Manual positive pressure ventilation seemed to worsen hypoxemia and tachycardia, while apnoeic oxygenation through circle system with valve open slightly improved cardiorespiratory collapse. The effect of positive ventilation, along with the absence of breath sounds in the right hemithorax and cardiorespiratory collapse, established the diagnosis of tension pneumothorax, managed immediately with emergency thoracentesis and placement of a thoracostomy tube. The patient was improved and pneumothorax was confirmed with chest X-ray and CT. The latter also confirmed the presence of bilateral multiple bullae. The operation was postponed and the patient was extubated a few hours later, in good condition. After thorough evaluation for any systemic disease, which was negative, the patient underwent two-stage thoracotomy for bullectomy.

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Hallifax, Rob, Magda Laskawiec-Szkonter, Melissa Dobson, Stephen Gerry, Robert F. Miller, John E. Harvey, and Najib Rahman. "Randomised Ambulatory Management of Primary Pneumothorax (RAMPP): protocol of an open-label, randomised controlled trial." BMJ Open Respiratory Research 6, no. 1 (April 2019): e000403. http://dx.doi.org/10.1136/bmjresp-2019-000403.

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IntroductionPneumothorax is a common clinical problem. Primary spontaneous pneumothorax (PSP) occurs in otherwise fit young patients, but optimal management is not clearly defined and often results in a long hospital stay. Ambulatory treatment options are available, but the existing data on their efficacy are poor. The Randomised Ambulatory Management of Primary Pneumothorax trial is a multicentre, randomised controlled trial comparing ambulatory management with standard care, specifically designed to safely and effectively reduce hospital stay.Methods and analysis236 patients with PSP will be recruited from UK hospitals. Patients will be randomised 1:1 to treatment to either the ‘Intervention’ arm (ambulatory device; Rocket Pleural Vent) or the ‘Control’ arm (aspiration ± standard chest drain insertion). Patients will be followed up for a total of 12 months to assess recurrence rates. The primary outcome is total length of stay in hospital (including readmissions) up to 30 days postrandomisation. The secondary outcomes are pain and breathlessness scores, air leak measurement and radiological evidence (on CT scanning) of emphysema-like changes, compared with short-term and long-term outcomes, respectively, and health economic analysis.Ethics and disseminationThe trial has received ethical approval from the National Research Ethics Service Committee South-Central Oxford A (15/SC/0240).Trial registration numberISRCTN79151659

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Fraser, Kristin L., Scott Wong, A. Reghan Foley, Sameer Chhibber, Carsten G. Bönnemann, Daniel J. Lesser, Carla Grosmann, and Anne Rutkowski. "Pneumothoraces in collagen VI-related dystrophy: a case series and recommendations for management." ERJ Open Research 3, no. 2 (April 2017): 00049–2017. http://dx.doi.org/10.1183/23120541.00049-2017.

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Collagen VI-related dystrophy (collagen VI-RD) is a rare neuromuscular condition caused by mutations in theCOL6A1,COL6A2orCOL6A3genes. The phenotypic spectrum includes early-onset Ullrich congenital muscular dystrophy, adult-onset Bethlem myopathy and an intermediate phenotype. The disorder is characterised by distal hyperlaxity and progressive muscle weakness, joint contractures and respiratory insufficiency. Respiratory insufficiency is attributed to chest wall contractures, scoliosis, impaired diaphragmatic function and intercostal muscle weakness. To date, intrinsic parenchymal lung disease has not been implicated in the inevitable respiratory decline of these patients.This series focuses on pneumothorax, an important but previously under-recognised disease manifestation of collagen VI-RD.We describe two distinct clinical presentations within collagen VI-RD patients with pneumothorax. The first cohort consists of neonates and children with a single pneumothorax in the setting of large intrathoracic pressure changes. The second group is made up of adult patients with recurrent pneumothoraces, associated with chest computed tomography scan evidence of parenchymal lung disease. We describe treatment challenges in this unique population with respect to expectant observation, tube thoracostomy and open pleurodesis.Based on this experience, we offer recommendations for early identification of lung disease in collagen VI-RD and definitive intervention.

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Endres, Felix, Judith Eva Spiro, Toki Anna Bolt, Amanda Tufman, Ben Ockert, Tobias Helfen, Fabian Gilbert, Boris M. Holzapfel, Wolfgang Böcker, and Georg Siebenbürger. "One-year follow-up—case report of secondary tension pneumothorax in a COVID-19 pneumonia patient." Infection 50, no. 2 (October 8, 2021): 525–29. http://dx.doi.org/10.1007/s15010-021-01711-9.

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Abstract Purpose The Coronavirus Disease 2019 (COVID-19) may result not only in acute symptoms such as severe pneumonia, but also in persisting symptoms after months. Here we present a 1 year follow-up of a patient with a secondary tension pneumothorax due to COVID-19 pneumonia. Case presentation In May 2020, a 47-year-old male was admitted to the emergency department with fever, dry cough, and sore throat as well as acute chest pain and shortness of breath. Sputum testing (polymerase chain reaction, PCR) and computed tomography (CT) confirmed infection with the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). Eleven days after discharge, the patient returned to the emergency department with pronounced dyspnoea after coughing. CT showed a right-sided tension pneumothorax, which was relieved by a chest drain (Buelau) via mini open thoracotomy. For a period of 3 months following resolution of the pneumothorax the patient complained of fatigue with mild joint pain and dyspnoea. After 1 year, the patient did not suffer from any persisting symptoms. The pulmonary function and blood parameters were normal, with the exception of slightly increased levels of D-Dimer. The CT scan revealed only discrete ground glass opacities (GGO) and subpleural linear opacities. Conclusion Tension pneumothorax is a rare, severe complication of a SARS-CoV-2 infection but may resolve after treatment without negative long-term sequelae. Level of evidence V.

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Xie, Ze-Xin, Xue-Tao Zhou, Dong-Sheng Zhang, Yang Yang, Guo-Liang Zhang, Meng-Hui Chen, and Zheng Liang. "Minimally invasive plate osteosynthesis for the treatment of sternal fracture in the lower chest: a case report." Journal of International Medical Research 47, no. 8 (July 31, 2019): 4033–38. http://dx.doi.org/10.1177/0300060519865074.

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Sternal fracture is a common complication of chest trauma but has a low incidence. Various treatments have been developed to reconstruct sternal fractures. Among these approaches, analgesia, corset fixation, and open reduction with plate internal fixation have been suggested. The use of newly developed minimally invasive plate osteosynthesis is a feasible method. In this study, we report a case involving a 54-year-old man with a sternal fracture accompanied by bilateral pleural effusion and a small amount of right-sided pneumothorax. The patient was treated with minimally invasive plate osteosynthesis. The operation was successful and the postoperative recovery was good. No pneumothorax or complications such as chest pain, paresthesia, or wound infection were observed at the 1-year follow-up visit. Additionally, the bilateral pleural effusion had been completely absorbed. The incision in the lower chest was aesthetic and minimally traumatic. This case describes a novel method for internal fixation of sternal fractures.

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Isakov, Arkadi, Arnold Shtein, and Sholmo Kyzer. "Pneumoretroperitoneum after Attempted Epidural Anesthesia." Journal of Critical Care Medicine 2, no. 4 (October 1, 2016): 198–200. http://dx.doi.org/10.1515/jccm-2016-0029.

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Abstract Air may extend to the retroperitoneal space from retroperitoneal perforation of a hollow viscus, infection of the anterior pararenal space with gas-forming organisms and from pneumothorax or pneumomediastinum [1]. Rare pathologies, such as open reduction and internal fixation of femoral fractures and anaerobic abscess of the hip joint have also been described in relation to this complication [1,2]. A rare case of pneumoretroperitoneum caused by insufflation of air during an attempt to achieve epidural anesthesia is described.

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Islam, Md Mahmudul, Khondkar AK Azad, Md Aminul Islam, and Rivu Raj Chakraborty. "Chest Trauma Evaluation and Outcome of Management in a Tertiary Hospital - One Year Experience." Journal of Surgical Sciences 22, no. 2 (March 22, 2020): 110–17. http://dx.doi.org/10.3329/jss.v22i2.44075.

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Background: Chest trauma is responsible for 50% of deaths due to trauma. This kind of death usually occurs immediately after the trauma has occurred. Various therapeutic options have been reported for management of chest injuries like clinical observation, thoracocentesis, tube thoracostomy and open thoracotomy. Objective: To observe the pattern and outcome of management in chest trauma Methods: This is an observational study carried out in Casualty department of Chittagong Medical College Hospital (CMCH), Chittagong, between April 2015 to March 2016. Our study was included all patients, both sexes, following chest injury at Casualty units of Chittagong Medical College Hospital. All the data were recorded through the preformed data collection sheet and analyzed. Result: The mean age was found 37.7±18.1 years with range from 12 to 80 years. Male female ratio was 11.8:1. The mean time elapsed after trauma was found 6.1±3.1 hours with range from 1 to 72 hours. Almost one third (35.7%) patients was affecting road traffic accident followed by 42(27.3%) assault, 35(22.7%) stab injury, 15(9.7%) fall and 7(4.5%) gun shot . More than three fourth (80.5%) patients were managed by tube thoracostomy followed by 28(18.2%) observation and 2(1.3%) ventilatory support. No thoracotomy was done in emergency department. 42(27.2%) patients was found open pneumothorax followed by 41(26.6%) rib fracture, 31(20.1%) haemopneumothorax, 14(9%) simple pneumothorax, 12(7.8%) haemothorax, 6(3.9%) chest wall injury, 5(3.2%) tension pneumothorax, and 3(1.9%) flail chest. About the side of tube 60(39.0%) patients were given tube on left side followed by 57(37.0%) patients on right side, 9(5.8%) patients on both (left & right) side and 28(18.2%) patients needed no tube. Regarding the complications, 13(30%) patients had persistent haemothorax followed by 12(29%)tubes were placed outside triangle of safety, 6(13.9%) tubes were kinked, 6(13.9%) patients developed port side infection, 2(4.5%)tube was placed too shallow, 2(4.5%) patients developed empyema thoracis and 2(4.5%) patients developed bronchopleural fistula. The mean ICT removal information was found 8.8±3.6 days with range from 4 to 18 days. Reinsertion of ICT was done in 6(4.7%) patients. More than two third (68.2%) patients were recovered well, 43(27.9%) patients developed complication and 6(3.9%)patients died. More than two third (66.9%) patients had length of hospital stay 11-20 days. Conclusion: Most of the patients were in 3rd decade and male predominant. Road traffic accident and tube thoracostomy were more common. Open pneumothorax, rib fracture and haemopneumothorax were commonest injuries. Nearly one third of the patients had developed complications. Re-insertion of ICT needed almost five percent and death almost four percent. Journal of Surgical Sciences (2018) Vol. 22 (2) : 110-117

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Choi, Jeff, Jenny Pan, Joseph D. Forrester, David Spain, and Timothy D. Browder. "LAPRA-TY for laparoscopic repair of traumatic diaphragmatic hernia without intracorporeal knot tying." Trauma Surgery & Acute Care Open 4, no. 1 (June 2019): e000334. http://dx.doi.org/10.1136/tsaco-2019-000334.

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Case PresentationA 38-year-old man was brought in by ambulance as a trauma activation after sustaining a self-inflicted stab wound in the left upper quadrant with a kitchen knife. His primary survey was unremarkable and his vital signs were normal. Secondary survey revealed a 2 cm transverse stab wound inferior and medial to the left nipple. Extended focused assessment with sonography for trauma (FAST) did not show intra-abdominal or pericardial fluid and chest X-ray did not show a definite pneumothorax or hemothorax.What would you do?Wound exploration at bedside.Admit for observation and serial examinations.Exploratory laparotomy and open repair of traumatic diaphragmatic injury (TDI).Thoracotomy and open repair of TDI.Diagnostic laparoscopy and laparoscopic repair of TDI.

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Kong, V. Y., M. Liu, B. Sartorius, and D. L. Clarke. "Open pneumothorax: the spectrum and outcome of management based on Advanced Trauma Life Support recommendations." European Journal of Trauma and Emergency Surgery 41, no. 4 (November 26, 2014): 401–4. http://dx.doi.org/10.1007/s00068-014-0469-5.

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Kitamura, Gene, and Christopher Deible. "Retraining an open-source pneumothorax detecting machine learning algorithm for improved performance to medical images." Clinical Imaging 61 (May 2020): 15–19. http://dx.doi.org/10.1016/j.clinimag.2020.01.008.

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Maccallum, Patricia L., Lorne S. Parnes, Michael D. Sharpe, and Chris Harris. "Comparison of Open, Percutaneous, and Translaryngeal Tracheostomies." Otolaryngology–Head and Neck Surgery 122, no. 5 (May 2000): 686–90. http://dx.doi.org/10.1016/s0194-5998(00)70197-5.

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INTRODUCTION: With 3 tracheostomy techniques currently available, controversy exists regarding which is safest and most economical. Percutaneous (PDT) and the new translaryngeal (TLT) tracheostomies are cited as more cost-effective than the traditional open surgical procedure because they are bedside techniques. Our objective was to compare the perioperative and postoperative complications of the 3 techniques. STUDY DESIGN: This was a prospective trial involving 100 consecutive patients who underwent tracheostomy between April and December of 1997 at the London Health Sciences Centre and St Joseph's Health Centre in London, Canada. RESULTS: Fifty open tracheostomies were performed. Indications included prolonged ventilation (n = 42), airway protection (n = 5), pulmonary hygiene (n = 2), and sleep apnea (n = 1). A tension pneumothorax was the one significant intraoperative complication. Fifteen postoperative complications occurred, most notable of which was a 2-L hemorrhage at 24 hours. Thirty-seven TLTs were performed, 20 in patients with coagulopathy. Indications were prolonged intubation (n = 27), airway protection (n = 9), and pulmonary hygiene (n = 1). One intraoperative complication of accidental decannulation occurred. One postoperative complication, a pretracheal abscess, occurred in a decannulated transplant patient 2 weeks after the procedure. Thirteen PDTs were performed. Indications were prolonged intubation (n = 6), airway protection (n = 6), and tracheal toilet (n = 1). No significant complications occurred. CONCLUSIONS: TLT and PDT have fewer complications than the traditional open technique. TLT appears to have the greatest utility in the coagulopathic patient.

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Maccallum, Patricia L., Lorne S. Parnes, Michael D. Sharpe, and Chris Harris. "Comparison of open, percutaneous, and translaryngeal tracheostomies." Otolaryngology–Head and Neck Surgery 122, no. 5 (May 2000): 686–90. http://dx.doi.org/10.1067/mhn.2000.104628.

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INTRODUCTION: With 3 tracheostomy techniques currently available, controversy exists regarding which is safest and most economical. Percutaneous (PDT) and the new translaryngeal (TLT) tracheostomies are cited as more cost-effective than the traditional open surgical procedure because they are bedside techniques. Our objective was to compare the perioperative and postoperative complications of the 3 techniques. STUDY DESIGN: This was a prospective trial involving 100 consecutive patients who underwent tracheostomy between April and December of 1997 at the London Health Sciences Centre and St Joseph's Health Centre in London, Canada. RESULTS: Fifty open tracheostomies were performed. Indications included prolonged ventilation (n = 42), airway protection (n = 5), pulmonary hygiene (n = 2), and sleep apnea (n = 1). A tension pneumothorax was the one significant intraoperative complication. Fifteen postoperative complications occurred, most notable of which was a 2-L hemorrhage at 24 hours. Thirty-seven TLTs were performed, 20 in patients with coagulopathy. Indications were prolonged intubation (n = 27), airway protection (n = 9), and pulmonary hygiene (n = 1). One intraoperative complication of accidental decannulation occurred. One postoperative complication, a pretracheal abscess, occurred in a decannulated transplant patient 2 weeks after the procedure. Thirteen PDTs were performed. Indications were prolonged intubation (n = 6), airway protection (n = 6), and tracheal toilet (n = 1). No significant complications occurred. CONCLUSIONS: TLT and PDT have fewer complications than the traditional open technique. TLT appears to have the greatest utility in the coagulopathic patient.

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Aleksi-Meskhishvili, V. V., and Yury A. Kozlov. "SURGICAL TREATMENT OF OPEN DUCTUS ARTERIOSUS IN PREMATURE INFANTS." Russian Journal of Pediatric Surgery 22, no. 6 (December 21, 2018): 301–5. http://dx.doi.org/10.18821/1560-9510-2018-22-6-301-305.

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The choice of tactics for the treatment of open arterial duct (OAD) in newborns is one of the most controversial and debatable topics in neonatal medicine. There are several approaches in the treatment of OAD in small infants: 1) the prophylactic use of cyclooxygenase inhibitors; 2) treatment on the background of maintenance therapy without the medical and surgical intervention; 3) drug stimulation of the closure of the AOA; 4) surgical intervention. Surgical treatment, which can be done with the aid of the open surgery and thoracoscopy, still plays a leading role. Complications associated directly with the operation are minimal. In this study, we present a review of the literature, including current information on the most frequent complications arising from the surgical treatment of OAD in newborns - damage to the lungs with the development of pneumothorax, damage to the great vessels with circulatory disorders, wound to the left phrenic nerve followed by paresis of the left diaphragm dome, damage to the recurrent nerve with impaired function of the left vocal cords, damage to the thoracic lymphatic duct with the development of chylothorax, damage to the muscles with development of functional scoliosis. Special attention is paid to the prognosis of the course of the disease and the survival rate of low birth weight infants.

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Vohra, H. A., L. Adamson, and D. F. Weeden. "Does video-assisted thoracoscopic pleurectomy result in better outcomes than open pleurectomy for primary spontaneous pneumothorax?" Interactive CardioVascular and Thoracic Surgery 7, no. 4 (April 16, 2008): 673–77. http://dx.doi.org/10.1510/icvts.2008.176081.

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Gencer, Mehmet, Erkan Ceylan, Muharrem Bitiren, and Ahmet Koc. "Two Sisters with Idiopathic Pulmonary Hemosiderosis." Canadian Respiratory Journal 14, no. 8 (2007): 490–93. http://dx.doi.org/10.1155/2007/150926.

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Idiopathic pulmonary hemosiderosis (IPH) is a rare cause of diffuse alveolar hemorrhage with unknown etiology. In the present report, the presentations of two sisters are described: one sister had IPH, eosinophilia and a high serum immunoglobulin E (IgE) level; and the other had IPH, pneumothorax, eosinophilia and a high serum IgE level. Both cases had quite unusual presentations. The first patient was 23 years of age, and had suffered from dry cough and progressive dyspnea for four years. Her hemoglobin level was 60 g/L, total serum IgE level was 900 U/mL and eosinophilia was 9%. Her chest radiography revealed diffuse infiltration. She died due to respiratory failure. The second patient was 18 years of age. She had also suffered from dry cough and gradually increasing dyspnea for two years. She had partial pneumothorax in the right lung and diffuse infiltration in other pulmonary fields on chest radiography. Her hemoglobin level was 99 g/L, total serum IgE level was 1200 U/mL and eosinophilia was 8%. IPH was diagnosed by open lung biopsy. All these findings suggested that familial or allergic factors, as well as immunological factors, might have contributed to the etiology of IPH.

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Sah, Suresh Prasad, R. Agrawal, CS Agrawal, and S. Koirala. "Profile of chest trauma patients at B.P. Koirala Institute of Health Sciences, Dharan, Nepal." Health Renaissance 13, no. 3 (August 3, 2017): 107–13. http://dx.doi.org/10.3126/hren.v13i3.17933.

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Background: Chest trauma is a major public health problem. It includes injury to chest wall, pleura, tracheobronchial tree, lungs, diaphragm, esophagus, heart and great vessels. It comprises 10-15% of all traumas and 25% of death due to trauma occurs because of chest injury. Chest trauma is seen with increasing frequency in urban hospitals.Methods: A prospective study of all pati with chest injury irrespective of age, sex and mode of injury presenting to BPKIHS emergency were included in this study from 15th March 2007 to 14th March 2008. Results: During the study period of one year total trauma patients presented toemergency were 1524. Out of this 122 patients were of chest injury. It comprises 8% of all trauma patients. Majority of patients belonged to the age group (21-40) years. Out of 122 patients, 57 (46.7%) patients sustained injury due to fall from height and was the commonest cause of trauma in this study followed by road traffic accident which was 38 (31.1%), 15 (12.3%) had physical assault and similar number of 6 patients (4.9%) sustained injury due to gunshot injury and stab injury. Out of 122 patients, 34 (27.9%) patients had associated injury. The most common chest injury was pneumothorax followed by isolated multiple rib fracture, hemothorax, isolated single rib fracture hemopneumothorax, flail chest, subcutaneous emphysema, lung contusion, open pneumothorax and tension pneumothorax.Conclusion: Majority of chest trauma patients were young adults with male preponderance. Blunt trauma chest was most common chest injury. Pneumothorax was the most common chest injury. Majority of patients were managed with tube thoracostomy, analgesics and chest physiotherapy. Health Renaissance 2015;13 (3): 107-113

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Bansal, Shivendu, Neena Jain, SohanLal Solanki, and VK Vijayvergia. "Pneumothorax complicating pulmonary embolism after combined spinal epidural anesthesia in a chronic smoker with open femur fracture." Journal of Anaesthesiology Clinical Pharmacology 27, no. 3 (2011): 403. http://dx.doi.org/10.4103/0970-9185.83695.

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Kong, VY, GV Oosthuizen, B. Sartorius, C. Keene, and DL Clarke. "An audit of the complications of intercostal chest drain insertion in a high volume trauma service in South Africa." Annals of The Royal College of Surgeons of England 96, no. 8 (November 2014): 609–13. http://dx.doi.org/10.1308/003588414x14055925058599.

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Introduction Intercostal chest drain (ICD) insertion is a commonly performed procedure in trauma and may be associated with significant morbidity. Methods This was a retrospective review of ICD complications in a major trauma service in South Africa over a four-year period from January 2010 to December 2013. Results A total of 1,050 ICDs were inserted in 1,006 patients, of which 91% were male. The median patient age was 24 years (interquartile range [IQR]: 20–29 years). There were 962 patients with unilateral ICDs and 44 with bilateral ICDs. Seventy-five per cent (758/1,006) sustained penetrating trauma and the remaining 25% (248/1006) sustained blunt trauma. Indications for ICD insertion were: haemopneumothorax (n=338), haemothorax (n=314), simple pneumothorax (n=265), tension pneumothorax (n=79) and open pneumothorax (n=54). Overall, 203 ICDs (19%) were associated with complications: 18% (36/203) were kinked, 18% (36/203) were inserted subcutaneously, 13% (27/203) were too shallow and in 7% (14/203) there was inadequate fixation resulting in dislodgement. Four patients (2%) sustained visceral injuries and two sustained vascular injuries. Forty-one per cent (83/203) were inserted outside the ‘triangle of safety’ but without visceral or vascular injuries. One patient had the ICD inserted on the wrong side. Junior doctors inserted 798 ICDs (76%) while senior doctors inserted 252 (24%). Junior doctors had a significantly higher complication rate (24%) compared with senior doctors (5%) (p<0.001). There was no mortality as a direct result of ICD insertion. Conclusions ICD insertion is associated with a high rate of complications. These complications are significantly higher when junior doctors perform the procedure. A multifaceted quality improvement programme is needed to improve the situation.

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Gambhir, Sahil, Areg Grigorian, Lourdes Swentek, Shelley Maithel, Brian M. Sheehan, Shaun Daly, Michael Lekawa, and Jeffry Nahmias. "Esophageal Trauma: Analysis of Incidence, Morbidity, and Mortality." American Surgeon 85, no. 10 (October 2019): 1134–38. http://dx.doi.org/10.1177/000313481908501012.

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Traumatic esophageal injury is a highly lethal but rare injury with minimal data in the trauma population. We sought to provide a descriptive analysis of esophageal trauma (ET) to identify the incidence, associated injuries, interventions, and outcomes. We hypothesized that blunt trauma is associated with higher risk of death than penetrating trauma. The Trauma Quality Improvement Program (2010–2016) was queried for patients with ET. Patients with blunt and penetrating trauma were compared using chi-square and Mann-Whitney U tests. A multivariable logistic regression model was used to determine risk of mortality. Of 1,403,466 adult patients, 651 (<0.01%) presented with ET. The most common associated thoracic injuries were rib fractures (38.7%) and pneumothorax (26.7%). More patients with a penetrating mechanism underwent open repair of the esophagus than those with blunt mechanism (46.2% vs 11.7%, P < 0.001). After controlling for covariates, there was no difference in risk of mortality between blunt and penetrating trauma ( P = 0.65). The mortality rate for patients with esophageal injury surviving greater than 24 hours was 7.5 per cent. In this large national database analysis, ET was rare and most commonly associated with rib fractures and pneumothorax. Contrary to our hypothesis, the risk of mortality was equivalent between blunt and penetrating ET.

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Hoehne, Francesca, Maria Ozaeta, and Ray Chung. "Routine Chest X-ray after Percutaneous Tracheostomy is Unnecessary." American Surgeon 71, no. 1 (January 2005): 51–53. http://dx.doi.org/10.1177/000313480507100109.

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Percutaneous tracheostomy (PT) is an increasingly common procedure in the management of critically ill patients. Current practice for both open and percutaneous tracheostomies is a post-procedure chest X-ray to rule out potentially life-threatening complications such as a pneumothorax or tube malposition. Our study evaluated the utility of chest X-ray after PT. A retrospective chart review was conducted for patients undergoing PT at Kern Medical Center between January 1999 and December 2003. Charts were reviewed for age, sex, and clinical outcome as well as the radiologist's interpretation of the postprocedure chest X-ray. A total of 73 procedures were completed in 47 men and 26 women. The majority of the tracheostomies were in trauma patients who needed prolonged ventilatory support. There were no complications identified on postprocedure chest X-ray. A single patient was converted to an open procedure secondary to bleeding. We conclude that routine chest X-ray after PT is unnecessary.

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Yang, Weijin, Youxu Zhou, Jianshen Qiu, Chaochao Tao, Weihang Wu, Nan Lin, Chao Yang, Ji Zhang, Hongwen Zhang, and Yu Wang. "An expandable one-way-valve device for chest wound treatment: Evaluation of open pneumothorax in a canine model." Asian Journal of Surgery 43, no. 8 (August 2020): 826–31. http://dx.doi.org/10.1016/j.asjsur.2019.10.013.

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Papazian, Laurent, Pascal Thomas, Fabienne Bregeon, Louise Garbe, Christine Zandotti, Pierre Saux, Francoise Gaillat, Michel Drancourt, Jean-Pierre Auffray, and Francois Gouin. "Open-lung Biopsy in Patients with Acute Respiratory Distress Syndrome." Anesthesiology 88, no. 4 (April 1, 1998): 935–44. http://dx.doi.org/10.1097/00000542-199804000-00013.

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Background It has been suggested that fibrosis present during the fibroproliferative phase of acute respiratory distress syndrome (ARDS) can be treated by corticosteroids. However, neither clinical nor microbiologic criteria permit differentiation of this fibroproliferative phase from a nosocomial pneumonia. The aim of this observational case series was to evaluate the safety and utility of open-lung biopsy (OLB) performed in patients receiving ventilatory support who had persistent ARDS despite negative bacterial cultures. Methods During a 4-yr period, 37 OLBs were performed in 36 of 197 patients receiving ventilatory support who had ARDS. The severity of ARDS was assessed by a lung injury score of 3.1 +/- 0.4 (mean +/- SD) and a median ratio of the partial pressure of oxygen (PaO2) to the fraction of inspired oxygen (FiO2) of 118 mmHg. Histologic examination; bacterial, fungal, and acid-fast staining; and cultures of the tissue sample were performed. Results Fibrosis was present in only 41% of the lung specimens obtained by OLB. Only six patients received corticosteroids (17%). In 9 of the 15 patients with fibrosis, cytomegalovirus pneumonia precluded the use of corticosteroids. Histologic cytomegalovirus pneumonia was diagnosed in 18 cases. Histologic bacterial or mycobacterial pneumonia was diagnosed in five cases. No significant change in arterial blood gases was noted as linked to the biopsy procedure except an increase of the PaO2/FiO2 ratio. One pneumothorax was diagnosed on a chest roentgenogram 12 h after OLB. Only one patient required blood transfusion during the 48-h period after OLB (for an hemothorax). Five patients had moderate air leaks from operative chest tubes for 2-10 days. Conclusions Open lung biopsy appeared to be a useful and acceptably safe diagnostic technique in patients with ARDS. It permitted the diagnosis of unexpected cytomegalovirus pneumonia.

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KOWALIK, MACIEJ MICHAŁ, PIOTR SIONDALSKI, MAGDALENA KOŁACZKOWSKA, WACŁAW ZAJĄC, PAULINA PAŁCZYŃSKA, EWELINA CACKOWSKA, GRZEGORZ JABŁOŃSKI, and ANDRZEJ BORMAN. "Challenges in using anesthesia for open chest and aorta surgery in swine." Medycyna Weterynaryjna 76, no. 08 (2020): 6426–2020. http://dx.doi.org/10.21521/mw.6426.

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Anesthesia for aorta surgery in pigs remains challenging due to the requirements for mechanical ventilation and the need for maintaining adequate homeostasis. We report an improved anesthesia protocol in an in vivo animal model to test a novel bacterial nanocellulose (BNC) within the ‘Kardio-BNC’ trial. Forty-four 6-month-old DanBred pigs comprising 6 males and 38 females (body weight ca. 82 kg) underwent implantation of pericardium reconstructive patches (n = 8), thoracic aorta prostheses (n = 15), or both procedures (n = 17) to test the biocompatibility of the novel BNC. The primary endpoint was 90-day survival, and the secondary outcome was death for any reason before reaching the study endpoint. Univariate analysis and linear regression were used to identify variables associated with premature mortality. Of the 44 pigs that underwent surgery, 10 (23%) were lost intra-operatively because of arrhythmia (n = 1), anesthesiological causes (n = 4), or surgical complications (n = 5). Modifications to tracheal intubation, tube fixation, temperature maintenance, and vascular catheterization increased the survival rate to 91% in the last quartile of the animals that underwent surgery. Of the 34 animals that survived surgery, n = 10 (29%) were lost post-operatively because of hematoma (n = 2), pneumothorax (n = 1), or infection (n = 7). Infection was associated with the type of surgery (highest prevalence in animals undergoing the combined procedure; p = 0.02), azaperone dose (p = 0.03), intra-operative heart rate variability (p = 0.03), and crystalloid transfusion (p = 0.04). The anesthesiological strategies and modifications to surgery described here allowed safe open chest and aorta surgery in up to 91% of the procedures performed

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Trindade, A. B., P. C. Basso, M. C. Gonçalves, G. A. Lima, D. G. Gerardi, C. A. C. Beck, E. A. Contesini, and M. V. Brun. "Laparoscopic paracostal herniorrhaphy in a dog: case report." Arquivo Brasileiro de Medicina Veterinária e Zootecnia 65, no. 6 (December 2013): 1641–46. http://dx.doi.org/10.1590/s0102-09352013000600008.

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Traumatic paracostal hernia is classified as an abdominal hernia that protrudes from the abdomen to a non physiologic space over the ribs. Treatment requires surgical reconstruction of the disrupted musculature in the thoracoabdominal region. Laparoscopic paracostal herniorrhaphy was performed in an eight-month-old male Teckel, presented after a car accident injury. A three-portal laparoscopic access was used for definitive diagnosis and hernia correction. After traction of the herniated omentum, a thoracoabdominal communication caused a left side pneumothorax, which was successfully drained with a chest tube placement. The herniorrhaphy was accomplished with intracorporeal sutures by a combination of Ford interlocking and cross mattress patterns. The postoperative period was uneventful. The laparoscopic paracostal herniorrhaphy was satisfactory, allowing both diagnosis and correction of the paracostal defect, showing to be a feasible alternative to the open surgery.

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Journal articles on the topic 'Open pneumothorax'

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