Spontaneous pneumothorax: treatment implications


pressure in the pleural cavity at rest has a slight negative pressure.It is the force that keeps the lung from the chest wall.If the pressure becomes positive, easy thrust elastic pulls him from the chest wall, and the vacated space is filled with air (pneumothorax) or fluid.Pneumothorax is divided into spontaneous and traumatic.Spontaneous is a condition caused by a rupture of pulmonary alveoli and the visceral pleura.It may be primary, that is not connected with any pulmonary pathology, or secondary, when the gap is a consequence of the disease - for example, emphysema, chronic obstructive pulmonary disease or tuberculosis.Changes in the external pressure, causing the expansion of the chest, such as during high altitude flight, and predisposes to the development of a pneumothorax.It happens that at the fracture formed tissue flap that acts as a valve.During inhalation, "valve" is opened and the air is sucked into the pleural cavity, exhale it closes, blocking air in the pleural area.Thus, a

t each inspiration volume of air in the pleural space increases.Lungs and mediastinum (the anatomical space located in the middle of the chest), move to the opposite side of the lesion, disrupting the normal lung.Deteriorating venous return to the heart and decreases cardiac output.This condition is known as tension pneumothorax.


patients with spontaneous pneumothorax feels a sudden attack of breathlessness, accompanied by a stabbing pain in his chest.In the limited mobility of the affected side of the chest wall.Respiratory sounds on auscultation (listening to the chest with a stethoscope usually) quieter than normal, and the sound can be heard in the percussion drum shade.In tension pneumothorax is noted increasing shortness of breath and mediastinal shift, which can be detected by determining the position of the trachea above the jugular notch of the sternum.


diagnosis is confirmed by chest X-ray, which is done with the full exhalation.Small pneumothorax sometimes not diagnosed, but it has no clinical significance.In an emergency, the time for examination may not be, and the physician must make the diagnosis on the basis of existing symptoms.In the case of tension pneumothorax in the absence of timely treatment, death can occur.Save the patient's life can pleural puncture - the introduction of a tube or needle into the pleural space to remove excess air.Doctors refer to the tension pneumothorax urgent conditions.In the absence of aid, it threatens the life of the patient.The pressure in the pleural cavity must be reduced by introducing an intercostal large hollow cannula or needle into the pleural cavity.


If the patient's condition is deteriorating rapidly, we must assume the existence of tension pneumothorax, and to take appropriate measures on the basis of only clinical data, without the use of X-rays.The needle is introduced through the chest wall into the pleural cavity leads to a decrease of pressure and increase in symptoms alert.A small amount of pneumothorax can heal spontaneously.If there are only minimal symptoms, atelectasis does not exceed 20% of its volume, and the patient leads a sedentary lifestyle, it makes sense to restrict observation of the patient with a regular chest X-rays before a pneumothorax resorption.In most cases, pneumothorax resolves within six weeks.If symptoms persist, pneumothorax should be allowed or aspiration of air through the hollow needle or via a pleural drainage.Intercostal cannula is inserted into the pleural cavity through the fourth or fifth intercostal space at the mid-axillary line, and then fixed with a seam.Catheter cannula connected to a vessel equipped with an outlet valve and filled with water.When the tube is located below the water level, the system operates as a check valve, and is gradually replaced by air from the pleural cavity.Sometimes for removing excess air requires aspiration.Aspiration through the needle is made by inserting the needle into the pleural cavity and the suction air by using the three-way valve.This procedure is less traumatic for the patient and helps reduce the time spent in the hospital.However, it is applicable only for small pneumothorax.If quickly removed from the pleural cavity of a large volume of air in the chest fluid may accumulate, causing lung edema unfolding.It happens that the pneumothorax is not permitted, since the initial hole in the visceral pleura remains open.This condition is known as bronchopleural fistula.In this case, the defect can be closed by a thoracotomy (surgical opening of the chest cavity) or thoracoscopy (minimally invasive technique in which to visualize and restore the pleural cavity using endoscopic instruments).25% pneumothorax subsequently recur and require definitive surgical correction.When a large amount of pneumothorax pleural drainage can also be effective.This occurs when the patient was already a bilateral pneumothorax in the past or it belongs to a professional group with a high risk of recurrence (eg aviapilot).In such cases, it can be carried out pleurodesis or pleurectomy.Purpose pleurodesis - splice visceral and parietal pleura using chemicals such as sterile talc or silver nitrate, or surgical scraping.The aim is to remove all plevrektomii modified pleural sheets, however, it results in significant scarring.