Pneumothorax in patients with acute respiratory distress syndrome: pathophysiology, detection, and treatment.
Pneumothorax is a frequent and potentially fatal complication of mechanical ventilation in patients with acute respiratory distress syndrome (ARDS). Prompt recognition and treatment of pneumothoraces is necessary to minimize morbidity and mortality. The radiologic and clinical signs of pneumothoraces in ARDS patients may have unusual and subtle features. Furthermore, small pneumothoraces in these patients can cause severe hemodynamic or pulmonary compromise. Sparse clinical literature exists on when or how to treat pneumothoraces once they develop in patients with ARDS. In this article, the authors review the pathogenesis, radiologic signs, clinical significance, and treatment of pneumothoraces in ARDS patients. Treatment options include traditional tube thoracostomy, open thoracotomy, and image-guided percutaneous catheters.
Woodside
Kenneth J
KJ
Division of Cardiothoracic Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA.
vanSonnenberg
Eric
E
Chon
Kenneth S
KS
Loran
David B
DB
Tocino
Irena M
IM
Zwischenberger
Joseph B
JB
D015984:Causality; D015505:Chest Tubes; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D018450:Disease Progression; D004630:Emergencies; D006439:Hemodynamics; D006801:Humans; D011030:Pneumothorax / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D015641:Radiography, Interventional; D013902:Radiography, Thoracic; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000628:therapy; D013907:Thoracostomy; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed