INCIDENCE OF PNEUMOTHORAX IN CASES WITH ARDS REQUIRING PEEP > 10 mmHg

M AHMAD; A IQBAL; I BASHIR; OM NAEEM; U ARSHAD; M KIRAN

doi:10.54112/bcsrj.v2023i1.529

Authors

M AHMAD Department of Pulmonology/Critical Care Medicine, Central Park Teaching Hospital, Lahore, Pakistan
A IQBAL Department of Pulmonology, Central Park Teaching Hospital, Lahore, Pakistan
I BASHIR Department of Pulmonology, Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan
OM NAEEM Department of Pulmonology, Pak Red Crescent Medical College/ Hospital, Lahore, Pakistan
U ARSHAD Department of Pulmonology Social Security Hospital, Gujranwala, Pakistan
M KIRAN Department of Pulmonology, Jinnah Hospital Lahore, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2023i1.529

Keywords:

Pneumothorax, Mechanical Ventilation, Positive End-Expiratory Pressure, ARDS

Abstract

This study aimed to determine the incidence of pneumothorax in patients with ARDS who require PEEP levels higher than ten mmHg. The study was conducted at the Department of Pulmonology and Critical Care, Central Park Teaching Hospital in Lahore, from January 2022 to June 2023. One hundred thirty-eight patients were enrolled in this cross-sectional study, and informed consent was obtained from all patients and their guardians. All patients underwent chest radiography or point of care ultrasound (POCUS) to identify pneumothorax. The results showed that 35 out of 138 patients (25.4%) had pneumothorax, and the mean PEEP value was 11.05±1.05. The study also found that male patients were more commonly affected than female patients (56.5% vs 42.8%). The practical implication of this study is that the diagnosis of pneumothorax is crucial in patients with ARDS, especially in the early stages, as this condition can lead to high mortality rates. The study can help pulmonologists choose better patient treatment options and avoid comorbidities. Conservative management may be recommended to patients if there are no clinical signs or symptoms of a severe condition and if the pneumothorax size is small. In conclusion, this study shows that patients with ARDS requiring PEEP levels higher than ten mmHg are at a higher risk of developing pneumothorax. Thus, early diagnosis and proper management are essential to improve patient outcomes.

Downloads

Download data is not yet available.

References

Boussarsar, M., Thierry, G., Jaber, S., Roudot-Thoraval, F., Lemaire, F., and Brochard, L. (2002). Relationship between ventilatory settings and barotrauma in the acute respiratory distress syndrome. Intensive care medicine 28, 406-413.

Charalampidis, C., Youroukou, A., Lazaridis, G., Baka, S., Mpoukovinas, I., Karavasilis, V., Kioumis, I., Pitsiou, G., Papaiwannou, A., and Karavergou, A. (2015). Pleura space anatomy. Journal of thoracic disease 7, S27.

Colt, H. G., Brewer, N., and Barbur, E. (1999). Evaluation of patient-related and procedure-related factors contributing to pneumothorax following thoracentesis. Chest 116, 134-138.

de Lassence, A., Timsit, J.-F., Tafflet, M., Azoulay, E., Jamali, S., Vincent, F., Cohen, Y., Garrouste-Orgeas, M., Alberti, C., and Dreyfuss, D. (2006). Pneumothorax in the intensive care unit: incidence, risk factors, and outcome. The Journal of the American Society of Anesthesiologists 104, 5-13.

Gattinoni, L., Bombino, M., Pelosi, P., Lissoni, A., Pesenti, A., Fumagalli, R., and Tagliabue, M. (1994). Lung structure and function in different stages of severe adult respiratory distress syndrome. Jama 271, 1772-1779.

Goizueta, A., and Bordoni, B. (2019). Anatomy, Thorax, Lung Pleura and Mediastinum. Stat Pearls Treasure Island (FL), 1-4.

Hsu, C.-W., and Sun, S.-F. (2014). Iatrogenic pneumothorax related to mechanical ventilation. World journal of critical care medicine 3, 8.

Jantz, M. A., and Pierson, D. J. (1994). Pneumothorax and barotrauma. Clinics in chest medicine 15, 75-91.

Rankine, J. J., Thomas, A. N., and Fluechter, D. (2000). diagnosis of pneumothorax in critically ill adults. Postgraduate medical journal 76, 399-404.

Sampson, A. C., Lassiter, B. P., Gregory Rivera, M., Hair, P. S., Jackson, K. G., Enos, A. I., Vazifedan, T., Werner, A. L., Glesby, M. J., and Lattanzio, F. A. (2021). Peptide inhibition of acute lung injury in a novel two-hit rat model. PloS One 16, e0259133.

Strange, C. (1999). Pleural complications in the intensive care unit. Clinics in chest medicine 20, 317-327.

Terzi, E., Zarogoulidis, K., Kougioumtzi, I., Dryllis, G., Kioumis, I., Pitsiou, G., Machairiotis, N., Katsikogiannis, N., Lampaki, S., and Papaiwannou, A. (2014). Acute respiratory distress syndrome and pneumothorax. Journal of thoracic disease 6, S435.

Tsuboshima, K., Kurihara, M., Yamanaka, T., Watanabe, K., Matoba, Y., and Seyama, K. (2020). Does a gender have something to do with clinical pictures of primary spontaneous pneumothorax? General Thoracic and Cardiovascular Surgery 68, 741-745.

Walkey, A. J., Del Sorbo, L., Hodgson, C. L., Adhikari, N. K., Wunsch, H., Meade, M. O., Uleryk, E., Hess, D., Talmor, D. S., and Thompson, B. T. (2017). Higher PEEP versus lower PEEP strategies for patients with acute respiratory distress syndrome. A systematic review and meta-analysis. Annals of the American Thoracic Society 14, S297-S303.

Wang, X.-h., Duan, J., Han, X., Liu, X., Zhou, J., Wang, X., Zhu, L., Mou, H., and Guo, S. (2021). High incidence and mortality of pneumothorax in critically Ill patients with COVID-19. Heart & Lung 50, 37-43.

Weg, J. G., Anzueto, A., Balk, R. A., Wiedemann, H. P., Pattishall, E. N., Schork, M. A., and Wagner, L. A. (1998). The relation of pneumothorax and other air leaks to mortality in the acute respiratory distress syndrome. New England Journal of Medicine 338, 341-346.

Wilkins, P. A., Otto, C. M., Baumgardner, J. E., Dunkel, B., Bedenice, D., Paradis, M. R., Staffieri, F., Syring, R. S., Slack, J., and Grasso, S. (2007). Acute lung injury and acute respiratory distress syndromes in veterinary medicine: consensus definitions: The Dorothy Russell Havemeyer Working Group on ALI and ARDS in Veterinary Medicine. Journal of Veterinary Emergency and Critical Care 17, 333-339.

Zhou, J., Lin, Z., Deng, X., Liu, B., Zhang, Y., Zheng, Y., Zheng, H., Wang, Y., Lai, Y., and Huang, W. (2021). Optimal Positive End Expiratory Pressure Levels in Ventilated Patients Without Acute Respiratory Distress Syndrome: A Bayesian Network Meta-Analysis and Systematic Review of Randomized Controlled Trials. Frontiers in Medicine, 1418.