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Continuing Education in Anaesthesia, Critical Care & Pain 2008 8(6):204-209; doi:10.1093/bjaceaccp/mkn038
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© The Board of Management and Trustees of the British Journal of Anaesthesia [2008]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Air leaks, pneumothorax, and chest drains

Elankumaran Paramasivam, MRCP
Locum Consultant in Respiratory Medicine
Leeds General Infirmary
Leeds LS1 3EX, UK

Andrew Bodenham, FRCA
Consultant in Anaesthesia and ICM
Anaesthetic department
Leeds General Infirmary
Leeds LS1 3EX, UK
Tel: +44 (0)113 392 2321 Fax: +44 (0)113 392 5682 E-mail: andy.bodenham@leedsth.nhs.uk

The first 150 words of the full text of this article appear below.


Key points

A plain PA or AP radiograph generally underestimates the size of a pneumothorax.
Simple aspiration is recommended as a first-line treatment for all primary pneumothoraces requiring intervention in the spontaneously breathing patient without CPAP.
Patients who develop a pneumothorax while on positive pressure ventilation or CPAP should be treated with a chest drain unless immediate weaning from positive pressure ventilation is possible.
A thoracic surgical opinion should be sought in cases of persistent large volume air leaks or failure of the lung to re-expand significantly within 4 days.
Except in rare cases of tension, air emphysema and pneumomediastinum are not life threatening and need observation only.
Tension pneumothorax is an unusual but a recognized cause of respiratory and cardiovascular compromise during anaesthesia and surgery.

 

Air leaks can be defined as any extrusion of air from normal gas-filled cavities including the upper airway, sinuses, tracheobronchial tree, and gastrointestinal (GI) . . . [Full Text of this Article]


   Pathophysiology
 

   Causes of pneumothorax
 

   Clinical features
 

   Subcutaneous emphysema, pneumomediastinum, and pneumopericardium
 

   Barotrauma and mechanical ventilation
 

   Distinction of pneumothorax from emphysematous bullae
 

   Investigations
 
Chest X-ray

Ultrasound

CT scan


   Management of pneumothorax
 
General

Aspiration

Chest drains and closed underwater systems


   Prevention strategies
 

   Bronchopleural fistula
 

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