title: Clinical characteristics, hospital outcome and prognostic factors of patients with ventilator-related pneumothorax.
abstract: BACKGROUND
  Mechanical ventilation is a common cause of iatrogenic pneumothorax in intensive care units (ICU). Most of the patients with ventilator-related pneumothorax (VRP) have underlying lung diseases and is associated with increased morbidity and mortality. The prognostic factors of VRP are not clear. The objective of this study was to find the possible prognostic factors.
  
  
  METHODS
  Analysis of retrospectively collected data of patients with pneumothorax induced by mechanical ventilation. Data were obtained concerning demographics, acute physiology and chronic health evaluation (APACHE) II score, organ failure, underlying diseases, interval between the start of mechanical ventilation and pneumothorax, arterial blood gas, respiratory parameters and patient outcomes.
  
  
  RESULTS
  One hundred and twenty-four patients with VRP were included for analysis. The incidence rate of VRP was 0.4% (124/31,660), and the mortality rate was 77.4%. The patients with VRP had higher hospital mortality rate than that of mechanically ventilated patients without pneumothorax (77.4% vs. 13.7%, P<0.001) or patient with procedure-related pneumothorax (77.4% vs. 29.4%, P<0.001). Most cases of VRP occurred in the early phase of mechanical ventilation, and 8.9% of the patients had a later episode of pneumothorax on the opposite lung. The interval between two episodes of VRP was short, at a median time of 2 days. Cox regression analysis showed that tension pneumothorax (P=0.001), PaO2/FiO2<200 (P=0.002), and APACHE II score (P=0.008) were significantly associated with death.
  
  
  CONCLUSIONS
  VRP patients with tension pneumothorax or PaO2/FiO2<200 had a higher risk of death. APACHE II scores were associated with mortality in the VRP patients with PaO2/FiO2≥200 mmHg.
authors.affiliation: Intensive Care Unit, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan - cwhsu2003@yahoo.com.
authors.forename: C-W
authors.initials: CW
authors.lastname: Hsu
authors.forename: S-F
authors.initials: SF
authors.lastname: Sun
authors.forename: D L
authors.initials: DL
authors.lastname: Lee
authors.forename: K-A
authors.initials: KA
authors.lastname: Chu
authors.forename: H-S
authors.initials: HS
authors.lastname: Lin
mesh_terms: D018806:APACHE; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011030:Pneumothorax / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055397:Ventilator-Induced Lung Injury / Q000453:epidemiology*
chemical_list: D010100:Oxygen