Recurrent pneumothoraces associated with nocturnal noninvasive ventilation in a patient with muscular dystrophy.
Although a common complication of mechanical ventilation in acute respiratory failure, spontaneous pneumothorax has been rarely reported among patients on chronic, intermittent, noninvasive positive pressure support. We report the first case of recurrent pneumothoraces associated with nocturnal bilevel positive airway pressure ventilation via a nasal mask.A 26-year old man with chronic respiratory failure secondary to an unclassified neuromuscular condition suffered four separate episodes of spontaneous pneumothorax over a 12-month period. Two episodes occurred while he was asleep on bilevel positive airway pressure support. He was found to have numerous subpleural blebs, and we propose a mechanism for their development. Following open pleurodesis and blebectomy, the patient has not had another pneumothorax. Given the increasing utilization of chronic nocturnal bilevel positive airway pressure ventilation, we suggest that healthcare providers and patients be made aware of this potentially life-threatening complication.
Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Lee R
LR
Choo-Kang
Folasade O
FO
Ogunlesi
Sharon A
SA
McGrath-Morrow
Thomas O
TO
Crawford
Carole L
CL
Marcus
D000328:Adult; D002908:Chronic Disease; D006801:Humans; D008297:Male; D009136:Muscular Dystrophies / Q000150:complications* / Q000628:therapy; D018700:Pleurodesis; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000209:etiology*; D011175:Positive-Pressure Respiration / Q000009:adverse effects*; D012008:Recurrence; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed