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Liao KM, Chiu CC, Lu HY. The risk of secondary spontaneous pneumothorax in patients with chronic obstructive pulmonary disease in Taiwan. Respir Med 2024; 228:107672. [PMID: 38763446 DOI: 10.1016/j.rmed.2024.107672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 05/12/2024] [Accepted: 05/16/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Secondary spontaneous pneumothorax (SSP) is often linked to chronic obstructive pulmonary disease (COPD). The frequency of SSP occurrence in COPD patients varies among different research findings. SSPs are more commonly found in the elderly population diagnosed with COPD. Previous studies have reported a pneumothorax rate of 26 per 100,000 COPD patients. There is, however, a notable lack of detailed epidemiological information regarding SSP in Asia. Our study focused on determining the occurrence rate of SSP among COPD patients in Taiwan using an extensive national database. Additionally, this study aimed to identify comorbidities associated with SSP in this patient group. METHODS In this study, we used the Longitudinal Health Insurance Database, which contains records of 2 million people who were randomly chosen from among the beneficiaries of the Taiwan National Health Insurance program. The dataset includes information from 2005 to the end of 2017. Our focus was on individuals diagnosed with COPD, identified through ICD-9-CM codes in at least one hospital admission or two outpatient services, with the COPD diagnosis date as the index date. The exclusion criteria included individuals younger than 40 years, those with incomplete records, or those with a previous diagnosis of pneumothorax before the index date. We conducted a matched comparison by pairing COPD patients with control subjects of similar age, sex, and comorbidities using propensity score matching. The follow-up for all participants started from their index date and continued until they developed pneumothorax, reached the study's end, withdrew from the insurance program, or passed away. The primary objective was to evaluate and compare the incidence of pneumothorax between COPD patients and matched controls. RESULTS We enrolled 65,063 patients who were diagnosed with COPD. Their mean age (±SD) was 66.28 (±12.99) years, and approximately 60 % were male. During the follow-up period, pneumothorax occurred in 607 patients, equivalent to 9.3 % of the cohort. The incidence rate of SSP in COPD patients was 12.10 per 10,000 person-years, whereas it was 6.68 per 10,000 person-years in those without COPD. Furthermore, COPD patients with comorbidities such as atrial fibrillation, congestive heart failure, coronary artery disease, diabetes mellitus, hypertension, and cancer exhibited an increased incidence of SSP compared to COPD patients without such comorbidities. This was observed after conducting a multivariable Cox regression analysis adjusted for age, sex, and other comorbidities. CONCLUSION Our study revealed an elevated risk of SSP in patients with COPD. It has also been suggested that COPD patients with comorbidities, such as atrial fibrillation, congestive heart failure, coronary artery disease, diabetes mellitus, hypertension, and cancer, have an increased risk of developing SSP.
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Affiliation(s)
- Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan; Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Chong-Chi Chiu
- Department of General Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Department of Medical Education and Research, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Hsueh-Yi Lu
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yun-Lin, Taiwan.
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Igai H, Sawabata N, Obuchi T, Matsutani N, Tsuboshima K, Okamoto S, Hayashi A. Current situation of management of spontaneous pneumothorax in Japan: A cross-sectional cohort study. Respir Investig 2024; 62:328-333. [PMID: 38401246 DOI: 10.1016/j.resinv.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/03/2024] [Accepted: 02/11/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Limited epidemiological information is available on spontaneous pneumothorax. To address this gap, the Japan Society for Pneumothorax and Cystic Lung Disease (JSPCLD) conducted a nationwide retrospective survey to investigate the current epidemiology of spontaneous pneumothorax in Japan. METHODS In this study, we conducted a retrospective cross-sectional cohort study to demonstrate the clinical features of spontaneous pneumothorax in one year from April 2019 to March 2020, compare patient characteristics and treatment outcomes between primary (PSP) and secondary spontaneous pneumothorax (SSP), and investigate the risk factors associated with in-hospital mortality among patients with SSP. RESULTS A total of 1784 patients from 28 institutions were enrolled in the study, with PSP observed in 956 cases (53.6%) and SSP in 817 cases (45.8%). The age distribution showed a biphasic peak caused by the different peaks between PSP and SSP. In-hospital mortality occurred in 42 cases (2.4%) among all patients, with 0 cases (0%) in PSP and 42 cases (5.1%) in SSP. Multivariable analyses revealed that interstitial pneumonia as an underlying disease (odds ratio: 2.4700, 95% confidence interval: 1.1100 to 5.4800, p = 0.0269), performance status≧3 (odds ratio: 7.3900, 95% confidence interval: 3.1900 to 17.2000, p < 0.0001), and lower value of serum albumin on admission (odds ratio: 0.4060, 95% confidence interval: 0.2140 to 0.7690, p = 0.0057) were significantly associated with in-hospital mortality among patients with SSP. CONCLUSIONS SSP patients with poor baseline conditions are at a higher risk for in-hospital mortality. It is crucial to provide close and meticulous management for SSP patients with compromised conditions.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura, Maebashi, Gunma, 371-0811, Japan.
| | - Noriyoshi Sawabata
- Department of Thoracic and Cardio-Vascular Surgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8511, Japan
| | - Toshiro Obuchi
- Department of Thoracic Surgery, St. Mary's Hospital, 422 Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan
| | - Noriyuki Matsutani
- Department of Surgery, Teikyo University Hospital, Mizonokuchi, 5-1-1 Futago, Takatsu, Kawasaki, Kanagawa, 213-8507, Japan
| | - Kenji Tsuboshima
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, 4-8-1 Seta, Setagaya, Tokyo, 158-0095, Japan
| | - Shouichi Okamoto
- Department of Respiratory Medicine, Saiseikai Ibaraki Hospital, 2-1-45 Mitsukeyama, Ibaraki, Osaka, 567-0035, Japan
| | - Akihiro Hayashi
- Department of General Thoracic Surgery, Shin Koga Hospital, 120 Tenjin, Kurume, Fukuoka, Japan
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Goyal A, Quazi MA, Syed R, Ikram HA, Sheikh FA, Farooq A, Sultan S, Sheikh AB. Investigating the Impact of Cannabis Consumption on Hospital Outcomes in Patients With Primary Spontaneous Pneumothorax: A Nationwide Analysis. Cureus 2024; 16:e55601. [PMID: 38586642 PMCID: PMC10995417 DOI: 10.7759/cureus.55601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Existing data suggest an association between primary spontaneous pneumothorax (PSP) and cannabis consumption, although evidence remains controversial. Methods This study used the 2016-2019 National Inpatient Sample Database to examine inpatients with PSP, categorizing them as cannabis users and non-users. Multivariate regression analyzed continuous variables, chi-square assessed categorical variables, and logistic regression models were built. Propensity score matching (PSM) mitigated the confounding bias. Results A total of 399,495 patients with PSP were admitted during the study period (13,415 cannabis users and 386,080 non-cannabis users). Cannabis users were more likely to be younger (p<0.001) and male (p<0.001) with a lower risk of baseline comorbidities than non-users. Cannabis users had a lower risk of sudden cardiac arrest, vasopressor use, the development of acute kidney injury, venous thromboembolism, the requirement for invasive and non-invasive mechanical ventilation, hemodialysis, ventilator-associated pneumonia, and the need for a tracheostomy. Cannabis use was associated with a 3.4 days shorter hospital stay (p<0.001), as confirmed by PSM analysis (2.3 days shorter, p<0.001). Additionally, cannabis users showed a lower risk of in-hospital mortality (p<0.001), a trend maintained in the PSM analysis (p<0.001). Conclusions Our study revealed correlations suggesting that cannabis users with PSP might experience lower in-hospital mortality and fewer complications than non-cannabis users.
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Affiliation(s)
- Aman Goyal
- Department of Internal Medicine, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
| | - Mohammed A Quazi
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, USA
| | - Rayika Syed
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, USA
| | - Hafiz Abdullah Ikram
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, USA
| | - Farooq A Sheikh
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, USA
| | - Asif Farooq
- Department of Family and Community Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Sulaiman Sultan
- Department of Nephrology, University of New Mexico School of Medicine, Albuquerque, USA
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, USA
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Skaarup SH, Laursen CB, Hallifax RJ, Iqbal B, Bødtger U. National survey on management of spontaneous pneumothorax from emergency department to specialised treatment: room for improvement. Eur Clin Respir J 2024; 11:2307648. [PMID: 38304715 PMCID: PMC10833110 DOI: 10.1080/20018525.2024.2307648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024] Open
Abstract
Introduction Spontaneous pneumothorax (SP) affects both young, otherwise healthy individuals and older persons with known underlying pulmonary disease. Initial management possibilities are evolving and range from observation to chest tube insertion. SP guidelines suggest an individualized approach based on multiple factors such as symptoms, size of pneumothorax, comorbidity and patient preference. Aim With this Danish national survey we aimed to map organization of care including involved specialties, treatment choice, training, and follow-up plans to identify aspects, and optimization of spontaneous pneumothorax management. Method A survey developed by the national interest group for pleural medicine was sent to all departments of emergency medicine, thoracic surgery, respiratory medicine, and to relevant departments of abdominal or orthopaedic surgery. Results The response rate was 75 % (47 of 65). Overall, 21% of responding departments had no guideline for SP management, which was provided by multiple specialties with marked heterogeneity in choice of treatment including tube size, management during admission, and referral procedure to follow-up. Few departments required procedure training, and nearly all of the responders called for improvements in management of pneumothorax. Conclusion This survey suggests that SP management and care is delivered heterogeneously across Danish hospitals with marked difference between respiratory physicians, emergency physicians, general surgeons and thoracic surgeons. It is therefore likely that management is sub-optimal. There is a need for a common Danish SP guideline to ensure optimal treatment across involved specialties.
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Affiliation(s)
- Søren Helbo Skaarup
- Department of Respiratory Medicine and Allergy, University Hospital. The Danish Respiratory Society’s interest group for pleural diseases, Aarhus, Denmark
| | - Christian B. Laursen
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Rob J Hallifax
- Oxford Respiratory Trials Unit, Churchill Hospital, University of Oxford, Oxford, UK
| | - Beenish Iqbal
- Oxford Respiratory Trials Unit, Churchill Hospital, University of Oxford, Oxford, UK
| | - Uffe Bødtger
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital Roskilde & Næstved, Zealand, Denmark
- Institute of Regional Health Reseach, University of Southern Denmark, Odense, Denmark
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Issoufou I, Sani R, Amadou D, Alio K, Adamou-Nouhou K, Lakranbi M, Sani R, Ouadnouni Y, Abarchi H, Smahi M. Which Role for Muscle-Sparing Posterolateral Thoracotomy in the Treatment of Spontaneous Pneumothorax? Surg J (N Y) 2023; 9:e149-e155. [PMID: 38197090 PMCID: PMC10754642 DOI: 10.1055/s-0043-1770954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 05/26/2023] [Indexed: 01/11/2024] Open
Abstract
Objective This study aims to show the place of muscle-sparing posterolateral thoracotomy in the treatment of spontaneous pneumothorax. Methods It was a single-center study performed in the Department of Thoracic Surgery of Teaching hospital Hassan II of Fez for 8 years. We adopted the nosological definition, which classifies spontaneous pneumothorax into three categories. We included patients over 15 years of age with primary or secondary spontaneous pneumothorax operated by posterolateral thoracotomy without muscle section, and we analyzed the specific indications of this approach. It included 49 patients with primary or secondary spontaneous pneumothorax, operated by muscle-sparing posterolateral thoracotomy. Data were collected from regularly updated computer files of patients, entered by Excel 2013, and analyzed using SPSS.20 software. These data are: epidemiological, clinical, radiological, surgical exploration, surgical procedure, the result of the surgery and the evolution. Results The average age was 42 years. Smoking was found in 61% of cases and pulmonary tuberculosis in 10% of cases. Thoracic computed tomography (CT) showed bullae and blebs in 31% of cases, pleural adhesions and pachypleuritis in 50% of cases, and hydropneumothorax with pachypleuritis in 37% of cases. There is a statistical correlation between pleuropulmonary decortication and pachypleuritis ( p = 0.002) or hydropneumothorax ( p = 0.001) on CT. Bullae and blebs resection was performed in 53% of cases and pleuropulmonary decortication in 63% of cases. A right pleuropneumonectomy was performed in one case. The follow-up was uneventful in 82% of cases. Conclusion Muscle-sparing posterolateral thoracotomy remains the best approach and leads to good results.
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Affiliation(s)
- Ibrahim Issoufou
- Department of Thoracic Surgery, Teaching Hospital Hassan II, Fez, Morocco
| | - Rabiou Sani
- Department of Thoracic Surgery, Teaching Hospital Hassan II, Fez, Morocco
| | - Daouda Amadou
- Department of Cardiovascular Surgery, Teaching Hospital Hassan II, Fez, Morocco
| | - Kadre Alio
- Department of Stomatology and Maxillofacial Surgery, Hôpital Général de Référence, Niamey, Niger
- Department of Surgery and Surgical Specialities, Faculty of Health Sciences, Abdou Moumouni University, Niamey, Niger
| | - Kaled Adamou-Nouhou
- Department of Cardiovascular Surgery, Teaching Hospital Hassan II, Fez, Morocco
| | - Marouane Lakranbi
- Department of Thoracic Surgery, Teaching Hospital Hassan II, Fez, Morocco
- Department of Surgery, Faculty of Medicine and Pharmacy, University Sidi Mohamed Ben Adellah, Fez, Morocco
| | - Rachid Sani
- Department of Surgery and Surgical Specialities, Faculty of Health Sciences, Abdou Moumouni University, Niamey, Niger
- Department of General Surgery, National Hospital of Niamey, Niamey, Niger
| | - Yassine Ouadnouni
- Department of Thoracic Surgery, Teaching Hospital Hassan II, Fez, Morocco
- Department of Surgery, Faculty of Medicine and Pharmacy, University Sidi Mohamed Ben Adellah, Fez, Morocco
| | - Habibou Abarchi
- Department of Surgery and Surgical Specialities, Faculty of Health Sciences, Abdou Moumouni University, Niamey, Niger
- Department of Pediatric Surgery, Hospital Amirou Boubacar Diallo, Niamey, Niger
| | - Mohamed Smahi
- Department of Thoracic Surgery, Teaching Hospital Hassan II, Fez, Morocco
- Department of Surgery, Faculty of Medicine and Pharmacy, University Sidi Mohamed Ben Adellah, Fez, Morocco
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Hallifax RJ. Cost Utility Analysis of Primary Spontaneous Pneumothorax Management: Another Reason to Choose Outpatient Options? Chest 2023; 164:829-830. [PMID: 37805243 DOI: 10.1016/j.chest.2023.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 10/09/2023] Open
Affiliation(s)
- Rob J Hallifax
- Oxford Respiratory Trials Unit, University of Oxford, Churchill Hospital, Oxford, England.
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Kanne JP, Rother MDM. Pneumothorax: Imaging Diagnosis and Etiology. Semin Roentgenol 2023; 58:440-453. [PMID: 37973273 DOI: 10.1053/j.ro.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/30/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Jeffrey P Kanne
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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Yi E, Park JE, Chung JH, Ahn CB, Chung E, Noh OK, Lee S. Trends in recurrence of primary spontaneous pneumothorax in young population after treatment for first episode based on a nationwide population data. Sci Rep 2023; 13:13478. [PMID: 37596298 PMCID: PMC10439191 DOI: 10.1038/s41598-023-39717-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/29/2023] [Indexed: 08/20/2023] Open
Abstract
The aim of this study is to identifying post treatment recurrence rates in pneumothorax patients under 35 and without any comorbidities according to the treatment types, gender, and age categories based on nationwide population data. Clinical information of pneumothorax patients was extracted from the Korean National Health Insurance Service (NHIS) database between January 2002 and December 2020. Enrolled patients were categorized into two groups; (1) Group I, those who underwent conservative management including pain relief, oxygen therapy, and closed thoracostomy, and (2) Group II, surgical intervention. Recurrence rates were compared according to age, gender, and type of treatment. Surgical intervention was performed in 25.6% patients as first treatment. The overall recurrence rate was 20.3%. Male patients showed a higher 5-year recurrence rate than female (20.8% vs. 10.9%, p < 0.001). Those with conservative management showed lower 5-year recurrence rates than those with surgical treatment (7.9% vs. 23.7%, p < 0.001). The 5-year recurrence rates of patients aged 14≤, and < 20 was higher than other age groups (29.2% vs. 4.5 and 11.9%, p < 0.001). Surgical intervention, male gender and aged under 20 showed association with higher recurrence rates.
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Affiliation(s)
- Eunjue Yi
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, 73, Koryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Jun Eun Park
- Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Ho Chung
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, 73, Koryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Chi Bum Ahn
- Biomedical Engineering Research Center, Asan Medical Center, Seoul, Republic of Korea
| | - Eugene Chung
- Department of Linguistics, Korea University, Seoul, Republic of Korea
| | - O Kyu Noh
- Department of Radiation Oncology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea.
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea.
- Office of Biostatistics, Ajou Research Institute for Innovative Medicine, Suwon, Republic of Korea.
| | - Sungho Lee
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, 73, Koryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
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Suter A, Müller ME, Daccord C, Taffé P, Lazor R. Probability of sporadic lymphangioleiomyomatosis in women presenting with spontaneous pneumothorax. Orphanet J Rare Dis 2023; 18:180. [PMID: 37415209 DOI: 10.1186/s13023-023-02784-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/18/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Sporadic lymphangioleiomyomatosis (S-LAM) is a rare low-grade neoplasm of young women characterized by multiple pulmonary cysts leading to progressive dyspnea and recurrent spontaneous pneumothorax (SP). The diagnosis of S-LAM may be delayed by several years. To reduce this delay, chest computed tomography (CT) screening has been proposed to uncover cystic lung disease in women presenting with SP. However, the probability to discover S-LAM in this population has not been determined precisely. The aim of this study was to calculate the probability of finding S-LAM in women presenting with (a) SP, and (b) apparent primary SP (PSP) as first manifestation of S-LAM. METHODS Calculations were made by applying the Bayes theorem to published epidemiological data on S-LAM, SP and PSP. Each term of the Bayes equation was determined by meta-analysis, and included: (1) the prevalence of S-LAM in the general female population, (2) the incidence rate of SP and PSP in the general female population, and (3) the incidence rate of SP and apparent PSP in women with S-LAM. RESULTS The prevalence of S-LAM in the general female population was 3.03 per million (95% confidence interval 2.48, 3.62). The incidence rate of SP in the general female population was 9.54 (8.15, 11.17) per 100,000 person-years (p-y). The incidence rate of SP in women with S-LAM was 0.13 (0.08, 0.20). By combining these data in the Bayes theorem, the probability of finding S-LAM in women presenting with SP was 0.0036 (0.0025, 0.0051). For PSP, the incidence rate in the general female population was 2.70 (1.95, 3.74) per 100,000 p-y. The incidence rate of apparent PSP in women with S-LAM was 0.041 (0.030, 0.055). With the Bayes theorem, the probability of finding S-LAM in women presenting with apparent PSP as first disease manifestation was 0.0030 (0.0020, 0.0046). The number of CT scans to perform in women to find one case of S-LAM was 279 for SP and 331 for PSP. CONCLUSION The probability of discovering S-LAM at chest CT in women presenting with apparent PSP as first disease manifestation was low (0.3%). Recommending chest CT screening in this population should be reconsidered.
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Affiliation(s)
- Audrey Suter
- Medical School, University of Lausanne, Lausanne, Switzerland
| | - Marie-Eve Müller
- Respiratory Medicine Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Cécile Daccord
- Respiratory Medicine Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Patrick Taffé
- Division of Biostatistics, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Romain Lazor
- Respiratory Medicine Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
- Service de Pneumologie, Centre Hospitalier Universitaire Vaudois, BU44.07.2137, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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Akyil M, Bayram S, Erdizci P, Tokgoz Akyil F, Ulusoy A, Evman S, Alpay L, Baysungur V. The prognostic effect of concomitant COVID-19 with spontaneous pneumothorax. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:352-357. [PMID: 37664778 PMCID: PMC10472460 DOI: 10.5606/tgkdc.dergisi.2023.23439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 05/20/2022] [Indexed: 09/05/2023]
Abstract
Background The aim of this study was to investigate the prevalence of novel coronavirus disease 2019 (COVID-19) in patients hospitalized with primary spontaneous pneumothorax and to evaluate its possible effects on the clinical course, treatment, and the prognosis. Methods Between April 2020 and January 2021, a total of 86 patients (78 males, 8 females; mean age: 27±5 years; range, 16 to 40 years) who had no underlying lung disease and were diagnosed with the first episode of spontaneous pneumothorax were retrospectively analyzed. At the same time of diagnosis, all patients were screened for COVID-19 via polymerase chain reaction test of nasopharyngeal swabs. According to the test results, the patients were divided into two groups as COVID-19(+) and COVID-19(-). The duration of air leak, hospital stay, recurrence rates and treatment modalities, and mortality rates of the two groups were compared. Results Following a pneumothorax diagnosis, 18 (21%) patients were diagnosed with COVID-19. In COVID-19(+) patients, the mean air leak and lung expansion duration were significantly longer (p<0.0001 for both). In these patients, the mean length of hospital stay was also significantly longer (p<0.0001). During the median follow-up of six months, no mortality was observed and the recurrence rate was similar between the two groups (p=0.998). Conclusion Our study results suggest that COVID-19 negatively affects the recovery time in patients with spontaneous pneumothorax.
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Affiliation(s)
- Mustafa Akyil
- Department of Thoracic Surgery, University of Health Sciences, Süreyyapaşa Training and Research Hospital, Istanbul, Türkiye
| | - Serkan Bayram
- Department of Thoracic Surgery, University of Health Sciences, Süreyyapaşa Training and Research Hospital, Istanbul, Türkiye
| | - Pelin Erdizci
- Department of Thoracic Surgery, University of Health Sciences, Süreyyapaşa Training and Research Hospital, Istanbul, Türkiye
| | - Fatma Tokgoz Akyil
- Department of Pulmonology, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Ayse Ulusoy
- Department of Thoracic Surgery, University of Health Sciences, Süreyyapaşa Training and Research Hospital, Istanbul, Türkiye
| | - Serdar Evman
- Department of Thoracic Surgery, University of Health Sciences, Süreyyapaşa Training and Research Hospital, Istanbul, Türkiye
| | - Levent Alpay
- Department of Thoracic Surgery, University of Health Sciences, Süreyyapaşa Training and Research Hospital, Istanbul, Türkiye
| | - Volkan Baysungur
- Department of Thoracic Surgery, University of Health Sciences, Süreyyapaşa Training and Research Hospital, Istanbul, Türkiye
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Vakil E, Taghizadeh N, Tremblay A. The Global Burden of Pleural Diseases. Semin Respir Crit Care Med 2023. [PMID: 37263289 DOI: 10.1055/s-0043-1769614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Pleural diseases include a spectrum of disorders broadly categorized into pneumothorax and pleural effusion. They often cause pain, breathlessness, cough, and reduced quality of life. The global burden of diseases reflects regional differences in conditions and exposures associated with pleural disease, such as smoking, pneumonia, tuberculosis, asbestos, cancer, and organ failure. Disease burden in high-income countries is overrepresented given the availability of data and disease burden in lower-income countries is likely underestimated. In the United States, in 2016, there were 42,215 treat-and-discharge visits to the emergency room for pleural diseases and an additional 361,270 hospitalizations, resulting in a national cost of $10.1 billion.
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Affiliation(s)
- Erik Vakil
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Niloofar Taghizadeh
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary and Emergency Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Alain Tremblay
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Marx T, Joly LM, Parmentier AL, Pretalli JB, Puyraveau M, Meurice JC, Schmidt J, Tiffet O, Ferretti G, Lauque D, Honnart D, Al Freijat F, Dubart AE, Grandpierre RG, Viallon A, Perdu D, Roy PM, El Cadi T, Bronet N, Duncan G, Cardot G, Lestavel P, Mauny F, Desmettre T. Simple Aspiration versus Drainage for Complete Pneumothorax: A Randomized Noninferiority Trial. Am J Respir Crit Care Med 2023; 207:1475-1485. [PMID: 36693146 DOI: 10.1164/rccm.202110-2409oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/24/2023] [Indexed: 01/26/2023] Open
Abstract
Rationale: Management of first episodes of primary spontaneous pneumothorax remains the subject of debate. Objectives: To determine whether first-line simple aspiration is noninferior to first-line chest tube drainage for lung expansion in patients with complete primary spontaneous pneumothorax. Methods: We conducted a prospective, open-label, randomized noninferiority trial. Adults aged 18-50 years with complete primary spontaneous pneumothorax (total separation of the lung from the chest wall), recruited at 31 French hospitals from 2009 to 2015, received simple aspiration (n = 200) or chest tube drainage (n = 202) as first-line treatment. The primary outcome was pulmonary expansion 24 hours after the procedure. Secondary outcomes were tolerance of treatment, occurrence of adverse events, and recurrence of pneumothorax within 1 year. Substantial discordance in the numerical inputs used for trial planning and the actual trial rates of the primary outcome resulted in a reevaluation of the trial analysis plan. Measurement and Main Results: Treatment failure occurred in 29% in the aspiration group and 18% in the chest tube drainage group (difference in failure rate, 0.113; 95% confidence interval [CI], 0.026-0.200). The aspiration group experienced less pain overall (mean difference, -1.4; 95% CI, -1.89, -0.91), less pain limiting breathing (frequency difference, -0.18; 95% CI, -0.27, -0.09), and less kinking of the device (frequency difference, -0.05; 95% CI, -0.09, -0.01). Recurrence of pneumothorax was 20% in this group versus 27% in the drainage group (frequency difference, -0.07; 95% CI, -0.16, +0.02). Conclusions: First-line management of complete primary spontaneous pneumothorax with simple aspiration had a higher failure rate than chest tube drainage but was better tolerated with fewer adverse events. Clinical trial registered with www.clinicaltrials.gov (NCT01008228).
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Affiliation(s)
| | - Luc-Marie Joly
- Service d'accueil des urgences, Centre hospitalier universitaire de Rouen, Rouen, France
| | | | - Jean-Baptiste Pretalli
- Centre Investigation Clinique INSERM 1431, Centre hospitalier universitaire de Besançon, Besançon, France
| | | | - Jean-Claude Meurice
- Service de pneumologie, Centre hospitalier universitaire de Poitiers, Poitiers, France
| | - Jeannot Schmidt
- Service d'accueil des urgences, Centre hospitalier universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Gilbert Ferretti
- Service de radiologie diagnostic et thérapeutique, Centre hospitalier universitaire de Grenoble, Grenoble, France
| | | | - Didier Honnart
- Service d'accueil des urgences, Centre hospitalier universitaire de Dijon, Dijon, France
| | - Faraj Al Freijat
- Service de pneumologie, Hôpital Nords Franche-Comté, Trévenans, France
| | - Alain Eric Dubart
- Service d'accueil des urgences, Centre hospitalier de Béthune, Béthune, France
| | - Romain Genre Grandpierre
- Service d'anesthésie et soins intensifs, Centre hospitalier universitaire de Nîmes, Nîmes, France
| | - Alain Viallon
- Service d'accueil des urgences, Centre hospitalier universitaire de Saint-Etienne, Saint-Etienne, France
| | - Dominique Perdu
- Service de pneumologie, Centre hospitalier universitaire de Reims, Reims, France
| | - Pierre Marie Roy
- Service d'accueil des urgences, Centre hospitalier universitaire d'Angers, Angers, France
| | - Toufiq El Cadi
- Service d'accueil des urgences, Groupe hospitalier de la Haute-Saône, Vesoul, France
| | - Nathalie Bronet
- Service d'accueil des urgences, Centre hospitalier Saint-Philibert-GHICL, Lomme, France
| | - Grégory Duncan
- Service d'accueil des urgences, Centre hospitalier Boulogne-sur-Mer, Boulogne-sur-Mer, France
| | - Gilles Cardot
- Service de chirurgie thoracique, Centre hospitalier Duchenne, Boulogne-sur-Mer, France; and
| | - Philippe Lestavel
- Service de soins intensifs, Polyclinique de Hénin-Beaumont, Hénin-Beaumont, France
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13
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Woo W, Kim BJ, Moon DH, Kang DY, Lee S, Oh TY. Oxidized Regenerated Cellulose versus Polyglycolic Acid for Pleural Coverage in Pneumothorax Surgery. J Clin Med 2023; 12:jcm12113705. [PMID: 37297900 DOI: 10.3390/jcm12113705] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/12/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Objectives: Although surgical intervention for spontaneous pneumothorax (SP) reduces the recurrence rate, thoracoscopic surgery is associated with greater postoperative recurrence rates than open thoracotomy. A polyglycolic acid (PGA) sheet or oxidized regenerated cellulose (ORC) mesh can therefore be used for additional coverage after thoracoscopic surgery, and this study compared the clinical impacts of these two materials. Methods: From 2018 to 2020, 262 thoracoscopic surgeries for primary SP were performed, of which 125 patients were enrolled in this study, and 48 and 77 patients received ORC and PGA coverage, respectively. The clinical characteristics and surgical procedures were reviewed, and the recurrence rates were compared. To obtain more comprehensive evidence, we performed a literature review and meta-analysis comparing ORC and PGA coverage. Results: There were no significant differences in patient characteristics between the two groups. Operating time was slightly shorter in the ORC group than in the PGA group (p = 0.008). The pneumothorax recurrence rate was similar in both groups (PGA: 10.4%, ORC: 6.2%, p = 0.529), but the recurrence-free interval was significantly longer (p = 0.036) in the ORC (262 days) than in the PGA (48.5 days) group. The literature review identified three relevant studies, and the meta-analysis revealed no difference in pneumothorax recurrence rate between the two coverage materials. Conclusions: The two visceral pleural coverage materials, PGA and ORC, did not show significant differences in postoperative pneumothorax recurrence. Therefore, if applied appropriately, the choice of material between ORC and PGA for thoracoscopic pneumothorax surgery does not have a significant impact on the clinical outcome.
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Affiliation(s)
- Wongi Woo
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Bong Jun Kim
- Department of Thoracic and Cardiovascular Surgery, National Health Insurance Service Ilsan Hospital, Goyang 10444, Republic of Korea
| | - Duk Hwan Moon
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Du-Young Kang
- Department of Thoracic and Cardiovascular Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul 03181, Republic of Korea
| | - Sungsoo Lee
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Tae Yun Oh
- Department of Thoracic and Cardiovascular Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul 03181, Republic of Korea
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Kumar VD, Rajesh P, Geman O, Craciun MD, Arif M, Filip R. “Quo Vadis Diagnosis”: Application of Informatics in Early Detection of Pneumothorax. Diagnostics (Basel) 2023; 13:diagnostics13071305. [PMID: 37046523 PMCID: PMC10093601 DOI: 10.3390/diagnostics13071305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
A pneumothorax is a condition that occurs in the lung region when air enters the pleural space—the area between the lung and chest wall—causing the lung to collapse and making it difficult to breathe. This can happen spontaneously or as a result of an injury. The symptoms of a pneumothorax may include chest pain, shortness of breath, and rapid breathing. Although chest X-rays are commonly used to detect a pneumothorax, locating the affected area visually in X-ray images can be time-consuming and prone to errors. Existing computer technology for detecting this disease from X-rays is limited by three major issues, including class disparity, which causes overfitting, difficulty in detecting dark portions of the images, and vanishing gradient. To address these issues, we propose an ensemble deep learning model called PneumoNet, which uses synthetic images from data augmentation to address the class disparity issue and a segmentation system to identify dark areas. Finally, the issue of the vanishing gradient, which becomes very small during back propagation, can be addressed by hyperparameter optimization techniques that prevent the model from slowly converging and poorly performing. Our model achieved an accuracy of 98.41% on the Society for Imaging Informatics in Medicine pneumothorax dataset, outperforming other deep learning models and reducing the computation complexities in detecting the disease.
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Affiliation(s)
- V. Dhilip Kumar
- School of Computing, Vel Tech Rangarajan Dr. Sagunthala R&D Institute of Science and Technology, Chennai 600062, India; (V.D.K.); (P.R.)
| | - P. Rajesh
- School of Computing, Vel Tech Rangarajan Dr. Sagunthala R&D Institute of Science and Technology, Chennai 600062, India; (V.D.K.); (P.R.)
| | - Oana Geman
- Department of Computers, Electronics and Automation, Faculty of Electrical Engineering and Computer Science, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
- Correspondence: (O.G.); (M.D.C.)
| | - Maria Daniela Craciun
- Interdisciplinary Research Centre in Motricity Sciences and Human Health, Ştefan cel Mare University of Suceava, 720229 Suceava, Romania
- Correspondence: (O.G.); (M.D.C.)
| | - Muhammad Arif
- Department of Computer Science, Superior University, Lahore 54000, Pakistan;
| | - Roxana Filip
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania;
- Suceava Emergency County Hospital, 720224 Suceava, Romania
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15
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Kwak HV, Banks KC, Hung YY, Brennan PG, Wilde SA, Sumner ET, Sun A, Hsu DS, Velotta JB. Utilization and Outcomes of Observation for Spontaneous Pneumothorax at an Integrated Health System. J Surg Res 2023; 288:28-37. [PMID: 36948030 DOI: 10.1016/j.jss.2023.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/10/2023] [Accepted: 02/17/2023] [Indexed: 03/22/2023]
Abstract
INTRODUCTION Though limited, recent evidence supports observation rather than intervention for spontaneous pneumothorax management. We sought to compare the utilization and outcomes between observation and intervention for patients with primary and secondary spontaneous pneumothoraces. METHODS A retrospective cohort study of all adults presenting to Kaiser Permanente Northern California emergency rooms with spontaneous pneumothorax from 2016 to 2020 was performed. Those with prior pneumothoraces, tension physiology, bilateral pneumothoraces, effusions, and prior thoracic procedures or surgery on the affected side were excluded. Groups included observation versus intervention. Baseline clinicodemographic variables and outcomes were compared. Treatment was considered successful if further interventions were not required for pneumothorax resolution. Wilcoxon rank-sum tests, chi-square tests, Fischer exact tests, and multivariable logistic regression models were performed. RESULTS Of the 386 patients with primary spontaneous pneumothorax, age, race/ethnicity, body mass index, smoking status, and the Charlson comorbidity index were not different between treatment groups. Of 86 patients with secondary spontaneous pneumothorax, age, gender, and smoking status were not different between treatment groups. Among patients with primary pneumothoraces, 83 underwent observation while 303 underwent intervention. The success rate was 92.8% for observation and 60.4% for intervention (P < 0.0001). Among patients with secondary pneumothoraces, 15 underwent observation while 71 underwent intervention, with a successful rate of 73.3% for observation and 32.4% for intervention (P = 0.003). CONCLUSIONS Given the high success rates for observation of both small and moderate primary and secondary pneumothoraces, observation should be considered for clinically stable patients. Observation may be the superior choice for decreasing morbidity and healthcare costs.
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Affiliation(s)
- Hyunjee V Kwak
- Department of Surgery, University of California San Francisco - East Bay, Oakland, California.
| | - Kian C Banks
- Department of Surgery, University of California San Francisco - East Bay, Oakland, California
| | - Yun-Yi Hung
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Phillip G Brennan
- Department of Surgery, University of California San Francisco - East Bay, Oakland, California
| | - Sawley A Wilde
- Department of Surgery, University of California San Francisco - East Bay, Oakland, California
| | - Eric T Sumner
- Department of Pulmonology. Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Angela Sun
- University of California, Berkeley, Berkeley, California
| | - Diana S Hsu
- Department of Surgery, University of California San Francisco - East Bay, Oakland, California
| | - Jeffrey B Velotta
- Department of Thoracic Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California
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16
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Jouneau S, Ricard JD, Seguin-Givelet A, Bigé N, Contou D, Desmettre T, Hugenschmitt D, Kepka S, Le Gloan K, Maitre B, Mangiapan G, Marchand-Adam S, Mariolo A, Marx T, Messika J, Noël-Savina E, Oberlin M, Palmier L, Perruez M, Pichereau C, Roche N, Garnier M, Martinez M. [Guidelines for management of patients with primary spontaneous pneumothorax]. Rev Mal Respir 2023; 40:265-301. [PMID: 36870931 DOI: 10.1016/j.rmr.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 03/06/2023]
Affiliation(s)
- S Jouneau
- Service de pneumologie, Centre de compétences pour les maladies pulmonaires rares, hôpital Pontchaillou, IRSET UMR 1085, université de Rennes 1, Rennes, France.
| | - J-D Ricard
- Université Paris Cité, AP-HP, DMU ESPRIT, service de médecine intensive réanimation, hôpital Louis-Mourier, Colombes, France; Inserm IAME U1137, Paris, France
| | - A Seguin-Givelet
- Département de chirurgie, Institut du thorax Curie-Montsouris, Institut Mutualiste Montsouris, université Paris Sorbonne Cité, Paris, France
| | - N Bigé
- Gustave-Roussy, département interdisciplinaire d'organisation du parcours patient, médecine intensive réanimation, Villejuif, France
| | - D Contou
- Réanimation polyvalente, centre hospitalier Victor-Dupouy, Argenteuil, France
| | - T Desmettre
- Emergency department, CHU Besançon, laboratory chrono-environnement, UMR 6249 Centre national de la recherche scientifique, université Bourgogne Franche-Comté, Besançon, France
| | - D Hugenschmitt
- Samu-Smur 69, CHU Édouard-Herriot, hospices civils de Lyon, Lyon, France
| | - S Kepka
- Emergency department, hôpitaux universitaires de Strasbourg, Icube UMR 7357, Strasbourg, France
| | - K Le Gloan
- Emergency department, centre hospitalier universitaire de Nantes, Nantes, France
| | - B Maitre
- Service de pneumologie, centre hospitalier intercommunal de Créteil, unité de pneumologie, GH Mondor, IMRB U 955, équipe 8, université Paris Est Créteil, Créteil, France
| | - G Mangiapan
- Unité de pneumologie interventionnelle, service de pneumologie, Groupe ECHOgraphie thoracique (G-ECHO), centre hospitalier intercommunal de Créteil, Créteil, France
| | - S Marchand-Adam
- CHRU de Tours, service de pneumologie et explorations respiratoires fonctionnelles, Tours, France
| | - A Mariolo
- Département de chirurgie, Institut du thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France
| | - T Marx
- Emergency department, CHU Besançon, laboratory chrono-environnement, UMR 6249 Centre national de la recherche scientifique, université Bourgogne Franche-Comté, Besançon, France
| | - J Messika
- Université Paris Cité, Inserm, physiopathologie et épidémiologie des maladies respiratoires, service de pneumologie B et transplantation pulmonaire, AP-HP, hôpital Bichat, Paris, France
| | - E Noël-Savina
- Service de pneumologie et soins intensifs respiratoires, Groupe ECHOgraphie thoracique (G-ECHO), CHU Toulouse, Toulouse, France
| | - M Oberlin
- Emergency department, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - L Palmier
- Pôle anesthésie réanimation douleur urgences, Nîmes university hospital, Nîmes, France
| | - M Perruez
- Emergency department, hôpital européen Georges-Pompidou, Paris, France
| | - C Pichereau
- Médecine intensive réanimation, centre hospitalier intercommunal de Poissy Saint-Germain, Poissy, France
| | - N Roche
- Service de pneumologie, hôpital Cochin, AP-HP, centre université Paris Cité, UMR1016, Institut Cochin, Paris, France
| | - M Garnier
- Sorbonne université, AP-HP, GRC29, DMU DREAM, service d'anesthésie-réanimation et médecine périopératoire Rive Droite, site Tenon, Paris, France
| | - M Martinez
- Pôle urgences, centre hospitalier du Forez, Montbrison, France; Groupement de coopération sanitaire urgences-ARA, Lyon, France
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17
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Jouneau S, Ricard JD, Seguin-Givelet A, Bigé N, Contou D, Desmettre T, Hugenschmitt D, Kepka S, Le Gloan K, Maître B, Mangiapan G, Marchand-Adam S, Mariolo A, Marx T, Messika J, Noël-Savina E, Oberlin M, Palmier L, Perruez M, Pichereau C, Roche N, Garnier M, Martinez† M. Recommandations formalisées d’experts pour la prise en charge des pneumothorax spontanés primaires. ANNALES FRANCAISES DE MEDECINE D URGENCE 2023. [DOI: 10.3166/afmu-2022-0472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Introduction : Le pneumothorax spontané primaire (PSP) est un épanchement gazeux dans la cavité pleurale, survenant hors traumatisme et pathologie respiratoire connue. Des recommandations formalisées d'experts sur le sujet sont justifiées par les pluralités de moyens diagnostiques, stratégies thérapeutiques et disciplines médicochirurgicales intervenant dans leur prise en charge.
Méthodes : Revue bibliographique, analyse de la littérature selon méthodologie GRADE (Grading of Recommendation Assessment, Development and Evaluation) ; propositions de recommandations cotées par experts, patients et organisateurs pour obtenir un consensus. Seuls les avis d'experts avec accord fort ont été retenus.
Résultats : Un décollement sur toute la hauteur de la ligne axillaire et supérieur ou égal à 2 cm au niveau du hile à la radiographie thoracique de face définit la grande abondance. La stratégie thérapeutique dépend de la présentation clinique : exsufflation en urgence pour PSP suffocant ; en l'absence de signe de gravité : prise en charge conservatrice (faible abondance), exsufflation ou drainage (grande abondance). Le traitement ambulatoire est possible si organisation en amont de la filière. Les indications, procédures chirurgicales et l'analgésie périopératoire sont détaillées. Les mesures associées, notamment le sevrage tabagique, sont décrites.
Conclusion : Ces recommandations sont une étape de l'optimisation des stratégies de traitement et de suivi des PSP en France.
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Pressure-dependent persistent air leak in a patient with secondary spontaneous pneumothorax. Am J Med Sci 2022; 364:782-788. [PMID: 35787363 DOI: 10.1016/j.amjms.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 04/03/2022] [Accepted: 06/27/2022] [Indexed: 01/25/2023]
Abstract
An air leak lasting more than 5-7 days (persistent air leak, PAL) can complicate up to 40% of patients with secondary spontaneous pneumothorax. Chronic obstructive pulmonary disease is the most common cause of secondary spontaneous pneumothorax, and early surgical intervention has been recommended for patients with PAL. Bullectomy or blebectomy with concomitant mechanical pleurodesis by medical thoracoscopy or video assisted thoracoscopic surgery is considered definitive therapy. Unfortunately, the perioperative course following lung resection can also be complicated by air leaks leading to worse clinical outcomes. Post lung resection air leak can be pressure independent or pressure dependent (also known as drainage-related air leak). The distinction between these two entities is crucial as the management varies drastically. Pleural manometry may play an important role in the early diagnosis of pressure-dependent PAL preventing further unnecessary surgical procedures from being performed.
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19
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Managing Spontaneous Pneumothorax. Ann Emerg Med 2022; 81:568-576. [PMID: 36328849 DOI: 10.1016/j.annemergmed.2022.08.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/17/2022] [Accepted: 08/17/2022] [Indexed: 11/22/2022]
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20
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Haberal MA, Akar E, Şengören Dikiş Ö, Özkaya M, Ay MO, Kaya H, Yüksel M. Effects of Atmospheric Changes on Spontaneous Pneumothorax. EURASIAN JOURNAL OF EMERGENCY MEDICINE 2022. [DOI: 10.4274/eajem.galenos.2021.68725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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21
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MIZUNO Y, SHIRAHASHI K, YAMAMOTO H, MATSUMOTO M, MIYAMOTO Y, KOMURO H, IWATA H. Importance of duration of chest tube placement for spontaneous pneumothorax as a risk factor for pleural infection. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.21.05367-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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22
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Iyoda A, Azuma Y, Sakai T, Koezuka S, Otsuka H, Sano A. Necessity of Multi-Step Surgical Treatment for Patients with Interstitial Lung Disease and a Pneumothorax. Ann Thorac Cardiovasc Surg 2022; 28:329-333. [PMID: 35922909 PMCID: PMC9585332 DOI: 10.5761/atcs.oa.22-00087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: A pneumothorax occurs in 3%–8% of patients with idiopathic pulmonary fibrosis. A pneumothorax may predict a poor outcome in patients with interstitial lung disease (ILD), and it is difficult to treat patients with ILD and a pneumothorax. Patients and Methods: We retrospectively studied data from all 12 patients with ILD and a pneumothorax who underwent surgical treatment at Toho University Omori Medical Center Hospital between 2009 and 2021. Results: Of the 12 patients, 2 had home oxygen therapy preoperatively and were classified with grade IV interstitial pneumonia (IP). Six patients had preoperative pleurodesis and two had postoperative one using auto-blood. Three patients (25%) had multi-step surgery ≥2, and 5 patients had surgical resection of bullae. No patients had postoperative acute exacerbations and all were discharged from the hospital in a stable condition. The 5-year overall survival rate for all patients was 70.0%. The median survival time was not reached. One patient with unclassified IP was doing well 116 months after surgery. Conclusion: Patients with ILD and a pneumothorax were shown to require multi-step surgical treatment and can anticipate long-term survival.
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Affiliation(s)
- Akira Iyoda
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Yoko Azuma
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Takashi Sakai
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Satoshi Koezuka
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Hajime Otsuka
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Atsushi Sano
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo, Japan
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23
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Smith C, Mobarakai O, Bux A, Kamel R, Mobarakai N. Secondary Pneumothorax Induced by a Bronchopleural Fistula in a Patient With COVID-19 Pneumonia. Cureus 2022; 14:e26627. [PMID: 35949738 PMCID: PMC9356666 DOI: 10.7759/cureus.26627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/05/2022] Open
Abstract
COVID-19 is a multi-system disease caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). One of the main highlights of the disease is the development of pneumonia complicated by adult respiratory distress syndrome. While spontaneous pneumothorax has been reported in some patients with COVID-19, bronchopleural fistula has seldom been reported as the primary cause in these cases. We describe the rare case of a young patient who developed a pneumothorax complicating COVID-19 and was found to have a bronchopleural fistula and empyema secondary to Staphylococcus aureus superinfection.
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24
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Daniels JMA. Management of primary spontaneous pneumothorax: don't hesitate, ambulate! Thorax 2022; 77:thoraxjnl-2022-218966. [PMID: 35732491 DOI: 10.1136/thoraxjnl-2022-218966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Johannes M A Daniels
- Department of Pulmonary Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, the Netherlands
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25
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A case report, bilateral spontaneous pneumothorax as a late complication for SARS CoV-2 infection. Radiol Case Rep 2022; 17:2265-2268. [PMID: 35510256 PMCID: PMC9061626 DOI: 10.1016/j.radcr.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 11/23/2022] Open
Abstract
The beta-coronavirus discovered in Wuhan in 2019 (COVID-19) provokes a series of affections from mild symptoms to life-threatening complications. There is evidence that associates the disease to spontaneous pneumothorax, however, the mechanism is unknown. The patient was a 45-year-old male with previous pneumonia due to COVID-19 who was attended the emergency department, where chest radiography was taken, confirming the diagnosis of right pneumothorax. However, the patient developed a new episode of pleuritic pain three days later, and a new radiograph showed left pneumothorax requiring a new chest tube. The simple tomography shows intraparenchymal bullae in the apical region of both lungs. The patient was kept under observation, and when improving, both endopleural chest drains were removed, and the patient was discharged. Spontaneous bilateral pneumothorax is a rare and potentially life-threatening complication. Identifying pulmonary bullae in patients with COVID-19 could be an early sign for these patients to develop spontaneous pneumothorax.
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Trivedi SB, Niemeyer M. Treating Recurrent Pleural Disease: A Review of Indications and Technique for Chemical Pleurodesis for the Interventional Radiologist. Semin Intervent Radiol 2022; 39:275-284. [PMID: 36062225 PMCID: PMC9433148 DOI: 10.1055/s-0042-1754349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Pleural space diseases such as recurrent pleural effusion and pneumothorax inflict a significant symptomatic burden on patients. Guidelines and studies are available to guide best practices in the setting of refractory effusions, mostly in the setting of malignancy, and recurrent pneumothorax. Less data is available to guide management of refractory transudative effusions. Recurrent pleural effusions can be treated with tunneled pleural catheters or catheter-based pleurodesis. While refractory transudative effusions can benefit from tunneled pleural catheter, this is an area of ongoing research. Regarding recurrent pneumothorax, video-assisted thoracoscopic surgery (VATS) pleurodesis using mechanical or laser/argon beam coagulation is the most effective means of preventing recurrence. Catheter based pleurodesis, a less invasive means of administering chemical sclerosant via percutaneous thoracostomy tube, is only used when surgery is not an option. However, both approaches induce inflammation of the pleural space, resulting in adherence of the parietal and visceral pleura to prevent fluid or air re-accumulation. This article will discuss catheter based chemical pleurodesis geared toward the interventional radiologist, including a review of disease processes and indications, technique, and strategies to mitigate complications as well as a literature review comparing percutaneous chemical pleurodesis to other therapies.
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Affiliation(s)
- Surbhi B. Trivedi
- Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Matthew Niemeyer
- Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
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Luengo-Fernandez R, Landeiro F, Hallifax R, Rahman NM. Cost-effectiveness of ambulatory care management of primary spontaneous pneumothorax: an open-label, randomised controlled trial. Thorax 2022; 77:913-918. [PMID: 35354647 DOI: 10.1136/thoraxjnl-2021-218479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/11/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Ambulatory management of primary spontaneous pneumothorax has been shown to reduce initial hospitalisation, but at the expense of increase adverse events. As a result, questions remain about the cost-effectiveness of this option. OBJECTIVES A within-trial economic evaluation alongside a randomised controlled trial was performed to assess the cost-effectiveness of ambulatory care when compared with standard guideline-based management. METHODS Patients were randomly assigned to treatment with either an ambulatory device or standard guideline-based management (aspiration, standard chest tube insertion or both). Follow-up was 12 months. Outcomes included healthcare resource use and costs, quality of life, quality-adjusted life-years (QALYs) and cost-effectiveness. RESULTS 236 patients were recruited and randomly assigned to ambulatory care (n=117) and standard care (n=119). After multiple imputation for missing data, patients in the ambulatory care group had significantly lower National Health Service healthcare costs (-£788, 95% CI difference: -1527 to -50; p=0.037) than those in the standard care group. There were no differences in the number of QALYs gained (mean difference: -0.001, 95% CI difference: -0.032 to 0.030; p=0.95). When standard care was compared with ambulatory care, the incremental cost-effectiveness ratio was £799 066 per QALY gained, well above current thresholds of cost-effectiveness. As a result, the probability of ambulatory care being cost-effective was 0.93. CONCLUSION Outpatient ambulatory management is highly likely to be a cost-effective option in the management of primary pneumothorax. TRIAL REGISTRATION NUMBER ISRCTN79151659.
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Affiliation(s)
| | - Filipa Landeiro
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rob Hallifax
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK .,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Najib M Rahman
- Oxford NIHR Biomedical Research Centre, Oxford, UK, University of Oxford, Oxford, UK
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Effectiveness of Video-Assisted Thoracoscopic Surgery with Bullectomy and Partial Pleurectomy in the Treatment of Primary Spontaneous Pneumothorax-A Retrospective Long-Term Single-Center Analysis. Healthcare (Basel) 2022; 10:healthcare10030410. [PMID: 35326888 PMCID: PMC8953604 DOI: 10.3390/healthcare10030410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/16/2022] [Accepted: 02/19/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Video-assisted thoracoscopic surgery (VATS) with bullectomy and partial pleurectomy (VBPP) is an increasingly used and well-established surgical treatment for primary spontaneous pneumothorax (PSP). However, reports on its effectiveness and long-term outcomes are limited. The aim of this study was to assess and compare long-term recurrence rates following VBPP and chest tube (CT) treatment and to identify potential risk factors for disease recurrence in patients with PSP. Methods: A total of 116 patients treated either by VBPP or CT were included in this study. Long-term recurrence rates and associations between clinical parameters and recurrence of pneumothorax were analyzed. Results: Sixty-two patients (53.4%) underwent VBPP, whereas 54 (46.6%) patients underwent CT treatment only. During a median follow-up period of 76.5 months, VBPP patients experienced a significantly lower recurrence rate compared to CT patients (6/62 vs. 35/54; p < 0.0001). CT treatment (VBPP vs. CT; p < 0.001) and a large initial pneumothorax size (Collins < 4 vs. Collins ≥ 4; p = 0.018) were independent risk factors for pneumothorax recurrence. Conclusion: VBPP is an effective and safe surgical treatment for PSP. Therefore, patients with a large pneumothorax size might benefit from VBPP, as they are at high risk for disease recurrence.
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Money NM, Schroeder AR, Quinonez RA, Ho T, Marin JR, Wolf ER, Morgan DJ, Dhruva SS, Coon ER. 2021 Update on Pediatric Overuse. Pediatrics 2022; 149:184542. [PMID: 35059726 PMCID: PMC9004348 DOI: 10.1542/peds.2021-053384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 02/03/2023] Open
Abstract
This update on pediatric medical overuse identifies and provides concise summaries of 10 impactful articles related to pediatric medical overuse from the years 2019 to 2020.
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Affiliation(s)
- Nathan M. Money
- Department of Pediatrics, University of Utah School of Medicine, Primary Children’s Hospital, Salt Lake City, Utah
| | - Alan R. Schroeder
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Ricardo A. Quinonez
- Division of Pediatric Hospital Medicine, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
| | - Timmy Ho
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jennifer R. Marin
- Departments of Pediatrics, Emergency Medicine, and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Elizabeth R. Wolf
- Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia
| | - Daniel J. Morgan
- University of Maryland School of Medicine and VA Maryland Health care System, Baltimore, Maryland
| | - Sanket S. Dhruva
- UCSF School of Medicine and San Francisco VA Medical Center, San Francisco, California
| | - Eric R. Coon
- Department of Pediatrics, University of Utah School of Medicine, Primary Children’s Hospital, Salt Lake City, Utah
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Özdemir S, Çitak N. Determination of Risk Factors for Recurrence in First Episode Pneumothorax. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03274-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Saha BK, Bonnier A, Chong WH, Chenna P. Successful use of endobronchial valve for persistent air leak in a patient with COVID-19 and bullous emphysema. BMJ Case Rep 2021; 14:14/11/e246671. [PMID: 34799393 PMCID: PMC8606771 DOI: 10.1136/bcr-2021-246671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Patients with SARS-CoV-2 pneumonia can suffer from pneumothorax and persistent air leak (PAL). The pneumothorax occurs with or without pre-existing lung disease. PAL refers to air leak lasting more than 5-7 days and arises due to bronchopleural or alveolopleural fistula. The management of PAL can be challenging as a standard management guideline is lacking. Here we present the case of a 42-year-old smoker with COVID-19 who presented to the hospital with fever, cough, acute left-sided chest pain and shortness of breath. He suffered from a large left-sided pneumothorax requiring immediate chest tube drainage. Unfortunately, the air leak persisted for 13 days before one-way endobronchial valve (EBV) was used with complete resolution of the air leak. We also review the literature regarding other cases of EBV utilisation for PAL in patients with COVID-19.
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Affiliation(s)
- Biplab K Saha
- Pulmonary and Critical Care Medicine, Ozarks Medical Center, West Plains, Missouri, USA
| | - Alyssa Bonnier
- Department of Nursing, Goldfarb School of Nursing at Barnes-Jewish College, St Louis, Missouri, USA
| | - Woon Hean Chong
- Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, New York, USA
| | - Praveen Chenna
- Pulmonary and Critical Care Medicine, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
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Cakmak M, Durkan A. Analysis of patients undergoing surgical treatment for primary spontaneous pneumothorax. Niger J Clin Pract 2021; 24:1669-1673. [PMID: 34782507 DOI: 10.4103/njcp.njcp_361_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Primary spontaneous pneumothorax (psp) results from spontaneous rupture of bleb or bulla. Aims: We planned to discuss the etiologic factors, clinical and radiological findings, and treatment results of psp cases. Materials and Methods 402 patients were evaluated. Patients were divided into two groups as patients receiving positive results with thoracostomy and patients who received positive results"> thoracotomy/video-assisted thoracoscopic surgery (vats). Groups were compared. Results were evaluated"> using Chi-square or Fishers' exact test. P < 0.05 was considered as significant. Results Gender difference (P: 1.00) and localization of disease (P: 0.45)were not significant for psp. Smoking and being subtotal or total compared to partial had a substantial effect on the implementation of thoracotomy/vats (P < 0.05). Furthermore, psp was most frequently seen in August and September. Discussion Risk factors of psp are described as genetic predisposition, being tall, smoking, and autosomal dominant heredity. The main determinant factor in the treatment of psp is the degree of pneumothorax. Conclusion Psp was frequently observed in smokers. The preferred method for overall psp is tube thoracostomy. Thoracotomy/vats is more commonly performed for subtotal or total psp compared to partial psp.
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Affiliation(s)
- M Cakmak
- Department of Thoracic Surgery, Fırat University Faculty of Medicine, Elazig, Turkey
| | - A Durkan
- Department of Thoracic Surgery, Health Sciences University Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
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Abstract
Pneumothorax is a common problem worldwide. Pneumothorax develops secondary to diverse aetiologies; in many cases, there may be no recognizable lung abnormality. The pathogenetic mechanism(s) causing spontaneous pneumothorax may be related to an interplay between lung-related abnormalities and environmental factors such as smoking. Tobacco smoking is a major risk factor for primary spontaneous pneumothorax; chronic obstructive pulmonary disease is most frequently associated with secondary spontaneous pneumothorax. This review article provides an overview of the historical perspective, epidemiology, classification, and aetiology of pneumothorax. It also aims to highlight current knowledge and understanding of underlying risks and pathophysiological mechanisms in pneumothorax development.
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Affiliation(s)
- Nai-Chien Huan
- Department of Pulmonology, Serdang Hospital, Kajang, Malaysia
| | - Calvin Sidhu
- Edith Cowan University, Perth, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Rajesh Thomas
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia; School of Medicine, University of Western Australia, Perth, Australia.
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The role of telomerase in the etiology of primary spontaneous pneumothorax. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:377-383. [PMID: 34589257 PMCID: PMC8462098 DOI: 10.5606/tgkdc.dergisi.2021.20522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/09/2020] [Indexed: 11/25/2022]
Abstract
Background
This study aims to investigate the role of telomerase activity in the risk of primary spontaneous pneumothorax, which is most frequently encountered in the practice of thoracic surgery.
Methods
A total of 61 patients (56 males, 5 females; median age: 29.4 years; range, 17 to 43 years) who underwent treatment for primary spontaneous pneumothorax and 19 age- and sex-matched healthy controls (10 males, 9 females; median age: 29.1 years; range, 23 to 43 years) were included in this prospective study between January 2018 - August 2018. Telomerase activity was evaluated with enzyme-linked immunosorbent assay. The correlation between telomerase activity and clinical and demographic parameters was examined.
Results
The mean serum telomerase level was 3.4±0.6 ng/mL in the primary spontaneous pneumothorax group and 1.9±0.5 ng/mL in the control group, indicating significantly higher levels in the patient group (p<0.001). There was no significant association between the telomerase levels and presence of blebs and/or bullae on thoracic computed tomography, extent of pneumothorax, laterality (right, left, or bilateral), and pack years of cigarette smoking.
Conclusion
Telomerase levels of patients with primary spontaneous pneumothorax are significantly higher than healthy individuals. Future genetic studies may ultimately clarify a potential relationship between primary spontaneous pneumothorax and short telomere syndrome.
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Epidemiology and Healthcare Utilization of Spontaneous Pneumothorax and Diffuse Cystic Lung Diseases in the United States. Ann Am Thorac Soc 2021; 18:534-536. [PMID: 32915058 DOI: 10.1513/annalsats.202006-648rl] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ben Chaib R, Aabdi M, Jakhjoukh D, Merbouh M, Mekkaoui I, Berrichi S, El Aidouni G, Bkiyar H, Housni B. Spontaneous gas effusions: A rare complication of covid 19. Ann Med Surg (Lond) 2021; 67:102508. [PMID: 34178313 PMCID: PMC8215879 DOI: 10.1016/j.amsu.2021.102508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 11/27/2022] Open
Abstract
Spontaneous gas effusion unrelated to assisted ventilation is a newly recognized complication of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The objective of the present study was to examine the incidence, risk factors and the outcomes of Spontaneous gas effusions. 610 cases were analyzable, with 3 patients developing spontaneous gas effusion. This latter was associated with increased intubation and a trend towards death in one case. Drainage was required in two cases. In conclusion, spontaneous gas effusions appeared to be a rare complication of severe acute respiratory syndrome. Further research is needed to investigate its pathogenesis. Several studies have demonstrated that Spontaneous gas effusion unrelated to assisted ventilation is a newly recognized complication of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The objective of the present study was to examine the incidence, risk factors and the outcomes of Spontaneous gas effusions. Spontaneous gas effusions during COVID-19 should not be neglected as it is associated with severe outcomes.
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Affiliation(s)
- Rajae Ben Chaib
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Mohammed Aabdi
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Douaa Jakhjoukh
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Manal Merbouh
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Ikram Mekkaoui
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Samia Berrichi
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Ghizlane El Aidouni
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Houssam Bkiyar
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Brahim Housni
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco.,Simulation Center for Medical Formation, Morocco
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Risk factors for recurrent spontaneous pneumothorax: A population level analysis. Am J Surg 2021; 223:404-409. [PMID: 34119331 DOI: 10.1016/j.amjsurg.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/27/2021] [Accepted: 05/27/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND We sought to determine the rate and risk factors of recurrent spontaneous pneumothorax in a diverse population. METHODS Cohort study using the California Public Discharge Data file (1995-2010). We identified patients with first-time spontaneous pneumothorax. The primary outcome was recurrent pneumothorax. Associations with clinical, patient, and hospital characteristics were assessed using Cox regression analysis. RESULTS Among 14,609 patients with a first-time episode of spontaneous pneumothorax, 26.2% developed a recurrence. Risk factors included age <35 (Hazard Ratio [HR] 1.24 95%-Confidence Interval [CI] 1.14-1.36), Asian race (HR 1.24, CI 1.13-1.37), and tube thoracostomy (HR 1.2, CI 1.15-1.31). Mechancial pleurodesis (HR 0.37 CI 0.31-0.45) was superior to chemical pleurodesis (HR 0.71 CI 0.58-0.86) in reducing recurrence risk. CONCLUSIONS The risk of recurrent pneumothorax is greatest in patients age <35, Asians, and those requiring a tube thoracostomy. The risks of operative intervention should be balanced against patient risk for recurrence.
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Garst M D M P H G, Asuquo AR. Aerospace Medicine Clinic. Aerosp Med Hum Perform 2021; 92:603-605. [PMID: 34503636 DOI: 10.3357/amhp.5487.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Muller ME, Daccord C, Taffé P, Lazor R. Prevalence of Birt-Hogg-Dubé Syndrome Determined Through Epidemiological Data on Spontaneous Pneumothorax and Bayes Theorem. Front Med (Lausanne) 2021; 8:631168. [PMID: 33987191 PMCID: PMC8111214 DOI: 10.3389/fmed.2021.631168] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/15/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Birt-Hogg-Dubé syndrome (BHD) is a rare inherited disorder characterized by cutaneous fibrofolliculomas, multiple pulmonary cysts, recurrent spontaneous pneumothorax (SP), and renal tumors. More than 40 years after its description, the prevalence of BHD in the general population remains unknown. This study aimed at determining the prevalence of BHD by applying the Bayes theorem of conditional probability to epidemiological data on SP. Methods: We performed a meta-analysis of published data on: (1) the probability of having BHD among patients with apparent primary SP (4 studies), (2) the incidence rate of primary SP in the general population (9 studies), and (3) the probability of experiencing a SP in BHD (16 studies). Results were corrected for SP relapses, stratified by gender and year of study publication (before and after 2000), and computed with the Bayes equation. Results: The probability of having BHD among patients with apparent primary SP was 0.09 (95% confidence interval: 0.07, 0.11) or 9%. It was 0.20 (0.14, 0.27) in women and 0.05 (0.04, 0.07) in men. The incidence rate of primary SP in the general population was 8.69 (6.58, 11.46) per 100,000 person-years (p-y). It was 3.44 (2.36, 4.99) per 100,000 p-y in women and 13.96 (10.72, 18.18) per 100,000 p-y in men, and was about 2 times higher in studies published after 2000 than in those published before 2000. The probability of experiencing at least one SP among patients with BHD was 0.43 (0.31, 0.54) or 43%, without gender difference. By combining these data in the Bayes equation, we found a prevalence of BHD in the general population of 1.86 (1.16, 3.00) per million, with values of 1.86 (1.02, 3.39) per million in men, and 1.88 (0.97, 3.63) per million in women. Conclusion: The prevalence of BHD in the general population is about 2 cases per million, without difference between genders.
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Affiliation(s)
- Marie-Eve Muller
- Respiratory Medicine Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Cécile Daccord
- Respiratory Medicine Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Patrick Taffé
- University Center for Primary Care and Public Health (Unisanté), DFRI/Division of Biostatistics, University of Lausanne, Lausanne, Switzerland
| | - Romain Lazor
- Respiratory Medicine Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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Nunna K, Braun AB. Development of a large spontaneous pneumothorax after recovery from mild COVID-19 infection. BMJ Case Rep 2021; 14:14/1/e238863. [PMID: 33462033 PMCID: PMC7813402 DOI: 10.1136/bcr-2020-238863] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
A previously healthy 37-year-old man presented with fevers and myalgias for a week with a minimal dry cough. Initial SARS-CoV-2 nasopharyngeal testing was negative, but in light of high community prevalence, he was diagnosed with COVID-19, treated with supportive care and self-quarantined at home. Three days after resolution of all symptoms, he developed sudden onset chest pain. Chest imaging revealed a large right-sided pneumothorax and patchy subpleural ground glass opacities. IgM and IgG antibodies for SARS-CoV-2 were positive. His pneumothorax resolved after placement of a small-bore chest tube, which was removed after 2 days. This case demonstrates that patients with COVID-19 can develop a significant pulmonary complication, a large pneumothorax, despite only minimal lower respiratory tract symptoms and after resolution of the original illness. Medical professionals should consider development of a pneumothorax in patients who have recovered from COVID-19 and present with new respiratory symptoms.
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Affiliation(s)
- Krishidhar Nunna
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Andrea Barbara Braun
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Iyoda A, Azuma Y, Sakai T, Koezuka S, Otsuka H, Sano A. A novel finding related to bulla and bleb formation in patients with primary spontaneous pneumothorax. BMC Pulm Med 2021; 21:20. [PMID: 33422030 PMCID: PMC7797130 DOI: 10.1186/s12890-021-01402-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/04/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Spontaneous pneumothorax is a common problem globally. Bullas and blebs have been implicated in this problem, but the etiology of their formation is unknown. We aim to show the relation between a novel clinical finding, the pulmonary delayed inflation (PDI) sign, and the etiology of bulla and bleb formation in young patients. METHODS We retrospectively analyzed data from 111 patients with pneumothorax and a control group of 27 patients. We evaluated the relation between the PDI sign and other clinical factors. RESULTS The PDI sign was observed in 78 patients. Of these, 75 exhibited the PDI sign in only the upper lobe. Regardless of smoking status, patients 34 years of age or younger had a significantly higher incidence of the PDI sign than, patients 55 years of age or older and control patients. The inflation time in patients 34 years of age or younger, regardless of smoking status, was significantly longer than in patients 55 years of age or older and patients in the control group. There was no significant association between inflation time and the presence of asthma. CONCLUSIONS The novel PDI sign is seen in patients 34 years of age or younger. Because this sign may indicate a peripheral bronchial abnormality and may be related to the formation of blebs and bullae in young patients with spontaneous pneumothorax, it is possible that it can be used to develop effective treatments for pneumothorax in young patients.
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Affiliation(s)
- Akira Iyoda
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Yoko Azuma
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Takashi Sakai
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Satoshi Koezuka
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Hajime Otsuka
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Atsushi Sano
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
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Yamazaki R, Nishiyama O, Gose K, Saeki S, Sano H, Iwanaga T, Tohda Y. Pneumothorax in patients with idiopathic pulmonary fibrosis: a real-world experience. BMC Pulm Med 2021; 21:5. [PMID: 33407311 PMCID: PMC7789641 DOI: 10.1186/s12890-020-01370-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 12/11/2020] [Indexed: 01/08/2023] Open
Abstract
Background Some patients with idiopathic pulmonary fibrosis (IPF) develop pneumothorax. However, the characteristics of pneumothorax in patients with IPF have not been elucidated. The purpose of this study was to clarify the clinical course, actual management, and treatment outcomes of pneumothorax in patients with IPF. Methods Consecutive patients with IPF who were admitted for pneumothorax between January 2008 and December 2018 were included. The success rates of treatment for pneumothorax, hospital mortality, and recurrence rate after discharge were examined. Results During the study period, 36 patients with IPF were admitted with pneumothorax a total of 58 times. During the first admission, 15 patients (41.7%) did not receive chest tube drainage, but 21 (58.3%) did. Of the 21 patients, 8 (38.1%) received additional therapy after chest drainage. The respective treatment success rates were 86.6% and 66.7% in patients who underwent observation only vs chest tube drainage. The respective hospital mortality rates were 13.3% and 38.0%. The total pneumothorax recurrence rate after hospital discharge was 34.6% (n = 9). Conclusions Pneumothorax in patients with IPF was difficult to treat successfully, had a relatively poor prognosis, and showed a high recurrence rate.
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Affiliation(s)
- Ryo Yamazaki
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Osamu Nishiyama
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan.
| | - Kyuya Gose
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Sho Saeki
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Hiroyuki Sano
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Takashi Iwanaga
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Yuji Tohda
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
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44
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Pleurodesis: From Thoracic Surgery to Interventional Pulmonology. Respir Med 2021. [DOI: 10.1007/978-3-030-80298-1_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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45
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Kang DH, Kim SY, Kim YE, Koh HJ, Ahn YH. Case of cytomegalovirus pneumonia presented as pneumothorax in 4-month-old healthy infant. ALLERGY ASTHMA & RESPIRATORY DISEASE 2021. [DOI: 10.4168/aard.2021.9.2.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Dong Hee Kang
- Department of Pediatrics, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Su Yeon Kim
- Department of Pediatrics, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Young Eun Kim
- Department of Pediatrics, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Hyo Jung Koh
- Department of Pediatrics, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Yeon Hwa Ahn
- Department of Pediatrics, Bundang Jesaeng Hospital, Seongnam, Korea
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46
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Kim D, Eom SY, Shin CS, Kim YD, Kim SW, Hong JM. The clinical effect of smoking and environmental factors in spontaneous pneumothorax: a case-crossover study in an Inland province. Ther Adv Respir Dis 2020; 14:1753466620977408. [PMID: 33287644 PMCID: PMC7727044 DOI: 10.1177/1753466620977408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: The factors that trigger spontaneous pneumothorax have not been sufficiently evaluated. The purpose of this study is to analyze the relationship between the development of spontaneous pneumothorax and meteorological parameters, including air pollutants. Methods: This is a retrospective study using the medical records of 379 patients who were admitted for spontaneous pneumothorax (SP) over a period of 4 years. Meteorological and air pollution data were obtained from the National Meteorological Office and the Ministry of Environment. We employed a case-crossover design to evaluate the short-term association between SP and meteorological factors including air pollutants. Conditional logistic regression was used to analyze bi-directional matched data. Results: Increase of relative humidity (RH) and of carbon monoxide (CO) were associated with the risk of pneumothorax, with odds ratio (OR) for RH = 1.18 (1.02–1.36), CO = 1.23 (1.02–1.48). Moreover, as air pressure (AP) decreased, risk of pneumothorax increased, with OR = 1.30 (1.05–1.59) but others did not. In the stratified analysis, the effect of RH was positive in ex-smokers (OR = 3.31) and non-smokers (OR = 1.32), but negative in current smokers (OR = 0.72). The effect of AP was significant in younger patients (OR = 1.33), males (OR = 1.40), and non-smokers (OR = 1.36). CO was related only with non-smokers (OR = 1.35) Conclusion: The triggering factors for spontaneous pneumothorax were relative humidity, carbon monoxide, and air pressure. The effect of the trigger was prominent in patients who were younger (<45 years), non- or ex-smokers, and male. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Dohun Kim
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Chungbuk National University and Chungbuk National University Hospital, 1 Chungdae-Ro, Seowon-Gu, Cheongju, Chungbuk, 28644, Korea
| | - Sang-Yong Eom
- Office of Public Healthcare Service, Chungbuk National University Hospital, Chungbuk, Korea
- Department of Preventive Medicine, Chungbuk National University, Chungbuk, Korea
| | - Chang-Seob Shin
- College of Agriculture, Life and Environmental Sciences, Department of Forest Science, Chungbuk National Universtiy, Cheongju, 28644, Korea
| | - Yong-Dae Kim
- Department of Preventive Medicine, Chungbuk National University, Chungbuk, Korea
| | - Si-Wook Kim
- Department of Thoracic and Cardiovascular Surgery, Chungbuk National University and Chungbuk National University Hospital, Chungbuk, Korea
| | - Jong-Myeon Hong
- Department of Thoracic and Cardiovascular Surgery, Chungbuk National University and Chungbuk National University Hospital, Chungbuk, Korea
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Dennison J, Carlson S, Faehling S, Lieb M, Mubarik A. Case report: Spontaneous pneumothorax in resolved, uncomplicated COVID-19 Pneumonia-A literature review. Respir Med Case Rep 2020; 31:101291. [PMID: 33200068 PMCID: PMC7658556 DOI: 10.1016/j.rmcr.2020.101291] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 02/07/2023] Open
Abstract
As the global COVID-19 pandemic has progressed, awareness of uncommon presentations and complications has increased. The actual incidence of spontaneous pneumothorax was found to be 0.66%, or six patients out of 902 who tested positive in recently published literature of 3368 patients (Zantah M, Dominguez Castillo E, Townsend R, Dikengil F, Criner GJ. Pneumothorax in COVID-19 disease-incidence and clinical characteristics. Respir Res. 2020 Sep 16; 21 (1):236.). Of those six patients, only two (0.22%) were not associated with mechanical ventilation barotrauma or comorbid lung disease such as COPD. Here, we present a spontaneous pneumothorax and pneumomediastinum in a patient four days after he had been discharged from hospitalization due to uncomplicated COVID-19 pneumonia.
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Affiliation(s)
| | | | | | - Margaret Lieb
- Medical College of Wisconsin, Wausau, WI, 54401, USA
| | - Ateeq Mubarik
- Ascension Saint Michael's Hospital, Stevens Point, WI, 54481, USA.,Medical College of Wisconsin, USA
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48
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Abstract
Background: The relationship between the 2019 novel coronavirus (COVID-19) and pneumothorax is not yet established. As of June 2020, few cases of nonintubated patients developing pneumothorax had been documented. Case Report: We present the case of an elderly patient with COVID-19 pneumonia that resulted in a prolonged hospital course because of pneumothorax complication. The patient did not develop severe symptoms and did not require intubation. Conclusion: This case report should aid clinicians assessing patients with COVID-19 pneumonia.
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49
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Alhakeem A, Khan MM, Al Soub H, Yousaf Z. Case Report: COVID-19-Associated Bilateral Spontaneous Pneumothorax-A Literature Review. Am J Trop Med Hyg 2020; 103:1162-1165. [PMID: 32666917 PMCID: PMC7470558 DOI: 10.4269/ajtmh.20-0680] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
COVID-19 is a pandemic caused by SARS-CoV-2, primarily affecting the respiratory tract. Pulmonary complications of COVID-19 may include acute respiratory distress syndrome and pulmonary embolism. Pneumothorax has been recently reported in association with COVID-19. We report a case of COVID-19 pneumonia with bilateral spontaneous pneumothorax with no known underlying lung disease or risk factors.
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Affiliation(s)
- Ayat Alhakeem
- Department of Family Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Muhammad Mohsin Khan
- Dresden International University, Dresden, Germany.,Department of Neurosurgery, Hamad Medical Corporation, Doha, Qatar
| | - Hussam Al Soub
- Weill Cornell Medicine, Doha, Qatar.,Department of Infectious Disease, Hamad Medical Corporation, Doha, Qatar
| | - Zohaib Yousaf
- Dresden International University, Dresden, Germany.,Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
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50
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Takahashi F, Takihara T, Nakamura N, Horio Y, Enokida K, Hayama N, Oguma T, Aoki T, Masayuki I, Asano K. Etiology and prognosis of spontaneous pneumothorax in the elderly. Geriatr Gerontol Int 2020; 20:878-884. [PMID: 32770645 DOI: 10.1111/ggi.13996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022]
Abstract
AIM Spontaneous pneumothorax shows a bimodal age distribution, with the secondary peak including patients aged ≥50 years. The purpose of this study was to clarify the etiology and prognosis of spontaneous pneumothorax in the elderly. METHODS Patients aged ≥50 years who were admitted to a tertiary university hospital between 2006 and 2016 due to spontaneous pneumothorax were retrospectively investigated. RESULTS Among 136 consecutive patients aged ≥50 years with spontaneous pneumothorax (mean age, 70 years; 114 men), 124 (91%) had underlying lung diseases, including pulmonary emphysema (42%) and interstitial pneumonia (27%). The median period of thoracic drainage was longer (14 days) in the cases with interstitial pneumonia than in the cases of primary pneumothorax (4 days; P < 0.001) and emphysema (9 days; P < 0.005). Eighteen patients (13%) died within 180 days after the onset of pneumothorax. The mortality rate was highest in the cases with interstitial pneumonia (27%) and was mostly associated with infectious complications. Death or worsened respiratory failure within 180 days from admission was associated with older age, systemic corticosteroid use and interstitial pneumonia in multivariate logistic regression analysis. CONCLUSIONS Pulmonary emphysema is the most common underlying disease associated with spontaneous pneumothorax in the elderly population. Pneumothorax associated with interstitial pneumonia is less frequent, but it requires prolonged tube thoracostomy and demonstrates higher mortality and morbidity, particularly in those receiving systemic corticosteroids. Different treatment strategies are warranted for patients with interstitial pneumonia-related pneumothorax. Geriatr Gerontol Int 2020; 20: 878-884.
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Affiliation(s)
- Fuminari Takahashi
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Takahisa Takihara
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Noriko Nakamura
- Department of Radiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Yukihiro Horio
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Keito Enokida
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Naoki Hayama
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Tsuyoshi Oguma
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Takuya Aoki
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Iwazaki Masayuki
- Division of Thoracic surgery, Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Koichiro Asano
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
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