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Study objective: To identify the prognostic factors for pneumothorax in patients in the ICU. Design: Retrospective cohort study.
Setting: ICU at a university-based teaching hospital.
Patients and methods: Sixty patients developed pneumothoraces in the ICU during a period of 36 months. Medical records relating to patients' age, sex, underlying diseases, associated medical conditions, reasons for admission, acute physiology and chronic health evaluation (APACHE) II scores, procedures performed before the development of pneumothorax, occurrences of tension pneumothorax, duration of chest tube placement, chest tube removal, duration of ICU stay, and patient outcomes all were analyzed. A multivariate logistic regression model was applied with variables that were significantly associated with survival in the univariate analysis. The probabilities of chest tube removal were calculated using the Kaplan-Meier method.
Results: Thirty-five patients (58%) had procedure-related pneumothoraces. The procedure that most commonly caused pneumothoraces was thoracentesis (n = 19; 54%), followed by central vein/pulmonary artery catheterization (n = 14; 40%) and bronchoscopy/transbronchial lung biopsy (n = 8; 23%). A multivariate logistic regression analysis also showed that pneumothorax due to barotrauma (p = 0.001), tension pneumothorax (p = 0.0023), and concurrent septic shock (p = 0.0476) were significantly and independently associated with death. The log-rank test revealed that the success rate of chest tube removal was higher in patients with procedurerelated pneumothoraces (p = 0.0055).
Conclusions: Patients with procedure-related pneumothoraces had better outcomes. Patients with pneumothoraces occurring in the ICU due to barotrauma, or a complicating tension pneumothoraces, carry a higher risk of mortality. (CHEST 2002; 122:678-683) Key words: barotrauma; ICU; mechanical ventilation; pneumothorax; thoracentesis
Abbreviations: APACHE = acute physiology and chronic health evaluation; RR = relative risk
Pneumothorax is the most common serious pleural complication in the ICU.1 Pneumothoraces may be difficult to diagnose when their locations are atypical, when the patient has underlying cardiopulmonary disease or altered mental status, or after peak physician staffing hours.2 The development of pneumothorax is most closely associated with the underlying disease, especially ARDS, and the occurrence of high airway pressures in ARDS.3 Patients who received mechanical ventilation had an incidence of pneumothorax of 4 to 15%.4-6 Iatrogenic pneumothorax following procedures is also an important etiology. Thoracic procedures, including thoracentesis, central venous catheter placement, bronchoscopy, pericardiocentesis, and tracheostomy, may pose a risk of...