IATROGENIC PNEUMOTHORAX

Abstract

Iatrogenic (a subtype of traumatic) pneumothorax commonly occurs as a complication of transthoracic puncture biopsy (TTPB), central venous catheterization (especially the subclavian vein), thoracocentesis, positive pressure mechanical ventilation (PPMV), transbronchial (TBB) and pleural biopsy. The incidence has recently been increasing due to the increasing use of invasive diagnostic and therapeutic procedures. The aim of this reseacrh is to present the results and the efficiency in the care of iatrogenic pneumothorax in the pneumophtisiologist practice in general hospital. Material and methods: the analysis includes 290 hospital histories (mainly from the Pulmonology Department, in a much smaller number from other Internal Medicine or Surgery Department at the GOB “September 8”) for a 4-year period (January 2018 - December 2021) with final discharge diagnoses: pleural effusion, pyothorax, lung cancer, pulmonary infiltration, pleural mesothelioma and metastatic pleural fluid - ICD codes: J90, J91, J86.9, C34, C45.0 and C78.2. All underwent an invasive diagnostic or therapeutic procedure. The diagnosis of pneumothorax included a radiological examination (PA-posteroanterior proection and LL -profile chest X-ray). Results: from 290 diagnostic-therapeutic procedures, immediately and up to 24 hours after the intervention, a total of 24 (8.3%) pneumothoraxes were recorded, namely: 15 (27%) out of 54 after TTPB, 3 (4.8%) of 62 after TBB and 3 (2%) of 124 after thoracocenthesis and percutaneous biopsyes of the parietal pleura. In 2 (4%) of 49 cases after lavage of the pleural space, partial pneumothorax was recorded, 1 complete hematopneumothorax after catheterization of the subclavian vein. Thoracic drainage was performed in 12 (50%) (initially in 9, and in 3 after 24 hours due to progression of incomplete lung collapse). Of the remaining 12 patients, the pneumothorax was treated with exufflation in 4, and in 8 conservatively (with a procedure of forced expiration and respiratory exercises). No case requiring a surgical approach has been registered. Conclusion: a condition for successful care of iatrogenic pneumothorax is compliance with standards in the application of diagnostic procedures in pulmonology and related areas, careful observation and efficient application of modern attitudes in care of complications from invasive-interventional diagnostic-therapeutic procedures.