The purpose of this study is to review the cases of pneumothorax (PTX) in our community hospital, and to determine the frequency, causes, morbidity, and one-month mortality rate (MR) of iatrogenic pneumothorax.
Retrospective study of all patients with pneumothorax in our community hospital between January 1999 and December 2003. Patients with iatrogenic PTX were identified, and data on the causes, need for chest tube (CT), need for mechanical ventilation (MV), and one-month MR were collected.
Iatrogenic PTX occurred in 86 patients (56%) out of 151 patients identified with PTX. The most common cause of iatrogenic pneumothorax was central venous catheter (CVC) placement (32 patients), followed by thoracentesis (26 patients), MV (17 patients), transthoracic needle aspiration (TTNA) (10 patients), and transbronchial biopsy (TBB) (1 patient). Among the patients with PTX following thoracentesis 9 patients (35%) were on MV. Need for CT, MV, and one-month MR is shown in the table.
Iatrogenic pneumothorax accounts for a large proportion of the PTX seen in our hospital. Central line insertion, thoracentesis, and MV are the main causes resulting in substantial morbidity and significant mortality in this group of critically ill patients.
When iatrogenic PTX occurs, it carries significant morbidity and mortality. In order to decrease the incidence of iatrogenic PTX, emphasis should be placed on prevention. Measures should include: 1) Proper choice of site of CVC insertion, internal jugular and femoral instead of subclavian, 2) Thoracentesis on patients on MV should be avoided if possible, or done under ultrasound guidance, and 3) Ventilator adjustments known to reduce barotrauma must be used in all patients on MV.
M. Alakhras, None.