title: Pneumothorax in the intensive care unit: incidence, risk factors, and outcome.
abstract: BACKGROUND
  The risk factors and outcomes of critically ill patients with iatrogenic pneumothorax (IP) have not been studied in a large unselected intensive care unit (ICU) population.
  
  
  METHODS
  The authors studied a prospective cohort of adults admitted for more than 24 h. Data were collected at ICU admission and daily by senior physicians until ICU discharge. Risk factors for IP were identified in the entire cohort. A matched nested case-control study was used to evaluate the excess risk of IP in decedents.
  
  
  RESULTS
  Of the 3,499 patients, 69 with pneumothorax before ICU admission were excluded. Of the remaining 3,430 patients, 94 experienced IP within 30 days (42 due to barotrauma and 52 due to invasive procedures). The cumulative incidence of IP was 1.4% (95% confidence interval [CI], 1.0-1.8) on day 5 and 3.0% (95% CI, 2.4-3.6) on day 30. Risk factors for IP (hazard ratio [95% CI]) were body weight less than 80 kg (2.4 [1.3-4.2]), history of adult immunodeficiency syndrome (2.8 [1.2-6.4]), diagnosis of acute respiratory distress syndrome (5.3 [2.6-11]) or cardiogenic pulmonary edema at admission (2.0 [1.1-3.6]), central vein or pulmonary artery catheter insertion (1.7 [1.0-2.7]), and use of inotropic agents during the first 24 h (2.1 [1.3-3.4]). Excess risk of IP in decedents was 2.6 (95% CI, 1.3-4.9; P = 0.004).
  
  
  CONCLUSIONS
  Iatrogenic pneumothorax is a life-threatening complication seen in 3% of ICU patients. Incorporating risk factors for IP into preventive strategies should reduce the occurrence of IP.
authors.affiliation: Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Louis Mourier Teaching Hospital, Colombes, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: de Lassence
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
authors.forename: Muriel
authors.initials: M
authors.lastname: Tafflet
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.forename: Samir
authors.initials: S
authors.lastname: Jamali
authors.forename: François
authors.initials: F
authors.lastname: Vincent
authors.forename: Yves
authors.initials: Y
authors.lastname: Cohen
authors.forename: Maïté
authors.initials: M
authors.lastname: Garrouste-Orgeas
authors.forename: Corinne
authors.initials: C
authors.lastname: Alberti
authors.forename: Didier
authors.initials: D
authors.lastname: Dreyfuss
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003422:Critical Care; D003625:Data Collection; D016208:Databases, Factual / Q000592:standards; D005260:Female; D005602:France; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011030:Pneumothorax / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D011786:Quality Control; D012307:Risk Factors; D016896:Treatment Outcome