Sunday, 24 November 2013

Pleural disease – Pneumothorax – The Complications

The pleura is a thin tissue covered by a layer of cells (mesothelial cells) that surrounds the lungs and lines the inside of the chest wall. A. Pneumothorax is defined as a condition of collection of air within the pleural cavity, from either the outside or from the lung of which affect the lung breathing.
C.1. Complications
1. Recurrence
Recurrent Pneumothorax is considered as one of the complications of patients with previous Pneumothorax. According to the study by the University of Thessaly, there is a report of recurrent spontaneous pneumothorax in a 42 years old woman with pulmonary lymphangioleiomyomatosis(22).
2. Persistent air-leak
Persistent air-leak in patients with spontaneous pneumothorax (SP) is not uncommon and can happen. In the study by the Tan Tock Seng Hospital, indicated that surgery is necessary for patients with air-leak persisting beyond 14 days, while favouring a conservative approach before this time, as the majority of air-leaks (especially in patients with primary pneumothorax) would resolve by 14 days(23).
3. Decrease of extracellular fluid volume (ECF)
In the study to test the hypothesis that persistent pneumothorax of greater than or equal to 6 days duration causes a decrease of extracellular fluid volume (ECF) in rabbits, showed that reduction of ECF in 53% of animals with pneumothorax plus hypoxemia (range -47% to +13%) and in 54% of animals with hypoxemia alone (range -26% to +25%). ECF declined in only 7% of normal controls and 20% of animals with pneumothorax without hypoxemia(24).
4. Hypoxemia
In the study to measure the Oxygen arterial partial pressure (PaO2) in 38 patients with idiopathic spontaneous pneumothorax (ISP) and in 20 of them 8-9 days after full expansion of the lung within 1-3 days by aspiration through chest tube drain, showed that the hypoxemia still observed after full expansion of the lung may be explained by the persistent small airway closure possibly due to increased surface tension and the subsequent transsudation still present in some peripheral air spaces(25).
5. Cardiac arrest
Tension pneumothorax during ventilating bronchoscopy for foreign body removal is a rare but life-threatening complication. There is a report of a case of cardiac arrest caused by tension pneumothorax in a 9-month-old girl who underwent ventilating bronchoscopy for foreign body (peanut) removal(26).
6. Respiratory failure
There is a report of a three-year-old child underwent anesthesia for urologic surgery presented respiratory failure by bronchial obstruction by secretion, evolving to atelectasis and hypertensive pneumothorax, according to Hospital Infantil Darcy Vargas(27). Other study describes the rapid development of respiratory insufficiency and near fatal pulmonary failure in a 65-year-old female patient with COPD due to spontaneous tension pneumothorax(28).
7. Shock
there is a report of a case of shock and ipsilateral pulmonary oedema after tube thoracostomy for spontaneous pneumothorax, according to the Royal Prince Alfred Hospital(29).

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