title: Pneumothorax as a complication of lung volume recruitment.
abstract: Lung volume recruitment involves deep inflation techniques to achieve maximum insufflation capacity in patients with respiratory muscle weakness, in order to increase peak cough flow, thus helping to maintain airway patency and improve ventilation. One of these techniques is air stacking, in which a manual resuscitator is used in order to inflate the lungs. Although intrathoracic pressures can rise considerably, there have been no reports of respiratory complications due to air stacking. However, reaching maximum insufflation capacity is not recommended in patients with known structural abnormalities of the lungs or chronic obstructive airway disease. We report the case of a 72-year-old woman who had poliomyelitis as a child, developed torsion scoliosis and post-polio syndrome, and had periodic but infrequent asthma attacks. After performing air stacking for 3 years, the patient suddenly developed a pneumothorax, indicating that this technique should be used with caution or not at all in patients with a known pulmonary pathology.
authors.affiliation: University Medical Center Utrecht, Department of Internal Medicine and Dermatology, Centre for Home Mechanical Ventilation Utrecht, The Netherlands, Utrecht. e.westermann@umcutrecht.nl
authors.forename: Erik J A
authors.initials: EJ
authors.lastname: Westermann
authors.forename: Maurice
authors.initials: M
authors.lastname: Jans
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gaytant
authors.forename: John R
authors.initials: JR
authors.lastname: Bach
authors.forename: Mike J
authors.initials: MJ
authors.lastname: Kampelmacher
mesh_terms: D000368:Aged; D001469:Barotrauma / Q000209:etiology*; D005260:Female; D006801:Humans; D007327:Insufflation / Q000009:adverse effects*; D008168:Lung / Q000473:pathology; D008176:Lung Volume Measurements / Q000379:methods; D011030:Pneumothorax / Q000209:etiology*; D011175:Positive-Pressure Respiration / Q000379:methods