title: CT-guided catheter drainage of loculated thoracic air collections in mechanically ventilated patients with acute respiratory distress syndrome.
abstract: OBJECTIVE
  We report our experience with CT-guided percutaneous catheter drainage of loculated thoracic air collections in mechanically ventilated patients with acute lung injury or acute respiratory distress syndrome.
  
  
  METHODS
  Nine critically ill patients had 17 air collections (13 pneumothoraces, three pneumatoceles, one tension pneumomediastinum) that either developed despite the presence of standard surgical chest tubes or were in loculated sites that were difficult to access. All nine patients were ventilated mechanically for a clinical diagnosis of acute respiratory distress syndrome. Catheter size ranged from 7- to 28-French. Response was measured by imaging follow-up, ventilatory parameters, and clinical outcome.
  
  
  RESULTS
  On follow-up imaging studies, all 17 air collections were shown to have been evacuated successfully. Catheters remained in place for a mean of 11 days (range, 4-28 days). No major complications occurred. Sixteen air collections were treated successfully with CT-guided catheter placement alone; the remaining air collection, a pneumothorax, was treated with subsequent placement of a chest tube by the surgeon at the patient's bedside. No surgery was undertaken for the air collections. Improvement in gas exchange was documented by increase in the hypoxemia ratio (arterial oxygen pressure divided by the inspired fraction of oxygen) in seven of 12 drainages; the other drainages were accompanied either by no improvement or by deterioration. Eight (89%) of the nine patients eventually were extubated and discharged from the hospital. The ninth patient died.
  
  
  CONCLUSIONS
  CT-guided percutaneous catheter drainage provided effective treatment for loculated thoracic air collections and obviated surgical intervention in these critically ill, high-surgical-risk patients.
authors.affiliation: Department of Radiology, The University of Texas Medical Branch, Galveston 77555-0709, USA.
authors.forename: K S
authors.initials: KS
authors.lastname: Chon
authors.forename: E
authors.initials: E
authors.lastname: vanSonnenberg
authors.forename: H B
authors.initials: HB
authors.lastname: D'Agostino
authors.forename: R M
authors.initials: RM
authors.lastname: O'Laoide
authors.forename: H G
authors.initials: HG
authors.lastname: Colt
authors.forename: E
authors.initials: E
authors.lastname: Hart
mesh_terms: D000328:Adult; D000368:Aged; D002408:Catheters, Indwelling; D015505:Chest Tubes; D004322:Drainage / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008478:Mediastinal Emphysema / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000601:surgery*; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000295:instrumentation*; D016896:Treatment Outcome