Incidence Of Pneumothorax In Patients Research Articles

Safety and efficacy of tract embolization using gelatin sponge particles in reducing pneumothorax after CT-guided percutaneous lung biopsy in patients with emphysema

BackgroundThe incidence of pneumothorax is higher in patients with emphysema who undergo percutaneous lung biopsy. Needle embolization has been shown to reduce the incidence of pneumothorax in patients with emphysema. Existing studies have reported small sample sizes of patients with emphysema, or the degree of emphysema has not been graded. Therefore, the efficacy of biopsy embolization in the prevention of pneumothorax induced by percutaneous pulmonary biopsy in patients with emphysema remains to be determined.MethodsIn this retrospective, controlled study, patients with emphysema who underwent CT-guided PTLB were divided into two groups: group A (n = 523), without tract embolization, and Group B (n = 504), with tract embolization. Clinical and imaging features were collected from electronic medical records and Picture Archiving and Communication Systems. Univariate and multivariate analyses were performed to identify risk factors for pneumothorax and chest tube placement.ResultsThe two groups did not differ significantly in terms of demographic characteristics and complications other than pneumothorax. The incidence of pneumothorax and chest tube placement in group B was significantly lower than in group A (20.36% vs. 46.12%, p < 0.001; 3.95% vs. 9.18%, p < 0.001, respectively). In logistic regression analyses, variables affecting the incidence of pneumothorax and chest tube placement were the length of puncture of the lung parenchyma (odds ratio [OR] = 1.18, 95% confidence interval [CI]: 1.07–1.30, p = 0.001; OR = 1.55, 95% CI: 1.30–1.85, p < 0.001, respectively), tract embolization (OR = 0.31, 95% CI: 0.24–0.41, p < 0.001; OR = 0.39, 95% CI: 0.22–0.69, p = 0.001, respectively), and grade of emphysema.ConclusionsTract embolization with gelatin sponge particles after CT-guided PTLB significantly reduced the incidence of pneumothorax and chest tube placement in patients with emphysema. Tract embolization, length of puncture of the lung parenchyma, and grade of emphysema were independent risk factors for pneumothorax and chest tube placement.Trial registrationRetrospectively registered.

INCIDENCE OF PNEUMOTHORAX IN CASES WITH ARDS REQUIRING PEEP &gt; 10 mmHg

This study aimed to determine the incidence of pneumothorax in patients with ARDS who require PEEP levels higher than ten mmHg. The study was conducted at the Department of Pulmonology and Critical Care, Central Park Teaching Hospital in Lahore, from January 2022 to June 2023. One hundred thirty-eight patients were enrolled in this cross-sectional study, and informed consent was obtained from all patients and their guardians. All patients underwent chest radiography or point of care ultrasound (POCUS) to identify pneumothorax. The results showed that 35 out of 138 patients (25.4%) had pneumothorax, and the mean PEEP value was 11.05±1.05. The study also found that male patients were more commonly affected than female patients (56.5% vs 42.8%). The practical implication of this study is that the diagnosis of pneumothorax is crucial in patients with ARDS, especially in the early stages, as this condition can lead to high mortality rates. The study can help pulmonologists choose better patient treatment options and avoid comorbidities. Conservative management may be recommended to patients if there are no clinical signs or symptoms of a severe condition and if the pneumothorax size is small. In conclusion, this study shows that patients with ARDS requiring PEEP levels higher than ten mmHg are at a higher risk of developing pneumothorax. Thus, early diagnosis and proper management are essential to improve patient outcomes.

Pneumothorax in lung metastasis of advanced soft tissue sarcoma patients treated with oral pazopanib.

Data on occurrence of pneumothorax after the use of oral pazopanib in advanced soft tissue sarcoma (STS) with lung metastases are scarce in literature. We aimed to evaluate those in our patients. This was a single center retrospective study of incidence of pneumothorax in patients with lung metastases in advanced STS treated with oral pazopanib between July, 2016 and December, 2020. Patients were treated with pazopanib usually from 2 nd line onwards with a dose ranging from 400 mg to 800 mg once daily. Total of 34 patients with lung metastasis in a setting of advanced STS were treated with oral pazopanib during the study period. The setting of pazopanib use was 2 nd line in four and 1 st line in one of them. The starting dose was 600 mg once daily in three patients, 400 mg OD in one patient, and 800 mg OD in one patient. Five patients developed pneumothorax with duration on pazopanib of 6, 7, 24, 6, and 2.5 months, respectively. Three patients had symptoms and required chest tube drainage. None of them were smokers or had any other underlying lung disease. The disease response of those patients was stable disease in four and partial response in one during treatment with pazopanib. One patient had a rechallenge with further pazopanib course without any recurrence of pneumothorax. Pneumothorax is a rare pulmonary complication after pazopanib use in patients with lung metastasis. Clinicians should be aware of this rare complication as literature is scarce. Rechallenge with pazopanib is feasible after pneumothorax.

Characteristics and Factors Associated With Mortality in Patients With Coronavirus Disease 2019 and Pneumothorax.

ObjectiveTo describe the incidence, clinical characteristics, and factors associated with mortality in patients hospitalized for coronavirus disease 2019 (COVID-19) in whom pneumothorax developed.Patients and MethodsThis study was a retrospective analysis conducted using a large administrative database of adult patients hospitalized for COVID-19 in the United States from February 1, 2020, to June 10, 2021. We characterized the clinical features of patients in whom pneumothorax developed and the factors associated with mortality and stratified pneumothorax by the timing of the initiation of invasive mechanical ventilation (IMV) and by the time of hospital admission (early versus late).ResultsA total of 811,065 adult patients had a positive test result for severe acute respiratory syndrome coronavirus 2, of whom 103,858 (12.8%) were hospitalized. Pneumothorax occurred in 1915 patients (0.24% overall and 1.84% among hospitalized patients). Over time, the use of steroids and remdesivir increased, whereas the use of IMV, pneumothorax rates, and mortality decreased. The clinical characteristics associated with pneumothorax were male sex; the receipt of IMV; and treatment with steroids, remdesivir, or convalescent plasma. Most patients with pneumothorax received IMV, but pneumothorax developed before the initiation of IMV and/or early during hospitalization in majority. Multivariable analysis revealed that pneumothorax increased the risk of death (adjusted hazard ratio [aHR], 1.15; 95% CI, 1.06-1.24). In patients who did not receive IMV, pneumothorax led to nearly twice the mortality (aHR, 1.99; 95% CI, 1.56-2.54). Increased mortality was also noted when pneumothorax occurred before IMV (aHR, 1.37; 95% CI, 1.11-1.69) and within 7 days of hospital admission (aHR, 1.60; 95% CI, 1.29-1.98).ConclusionThe overall incidence of pneumothorax in patients hospitalized for COVID-19 was low. Pneumothorax is an independent risk factor for death.

Clinical Outcome of CT-Guided Stereotactic Ablative Brachytherapy for Unresectable Early Non-Small Cell Lung Cancer: A Retrospective, Multicenter Study.

ObjectiveTo analyze the efficacy and safety of low dose rate stereotactic ablative brachytherapy (L-SABT) for treatment of unresectable early-stage non-small cell lung cancer (NSCLC).MethodsData of patients with early-stage NSCLC who received CT-guided L-SABT (radioactive I-125 seeds implantation) at eight different centers from December 2010 to August 2020 were retrospectively analyzed. Treatment efficacy and complications were evaluated.ResultsA total of 99 patients were included in this study. Median follow-up duration was 46.3 months (6.1-119.3 months). The 1-year, 3-year, and 5-year local control rates were 89.1%, 77.5%, and 75.7%, respectively. The 1-year, 3-year, and 5-year overall survival rates were 96.7%, 70.1%, and 54.4%, respectively. Treatment failure occurred in 38.4% of patients. Local/regional recurrence, distant metastasis, and recurrence combined with metastasis accounted for 15.1%, 12.1%, and 11.1%, respectively. Pneumothorax occurred in 47 patients (47.5%) with 19 cases (19.2%) needing closed drainage. The only radiation-related adverse reaction was two cases of grade 2 radiation pneumonia. KPS 80–100, T1, the lesion was located in the left lobe, GTV D90 ≥150 Gy and the distance between the lesion and chest wall was < 1 cm, were associated with better local control (all P < 0.05); on multivariate analysis KPS, GTV D90, and the distance between the lesion and chest wall were independent prognostic factors for local control (all P < 0.05). KPS 80–100, T1, GTV D90 ≥150 Gy, and the distance between the lesion and chest wall was < 1 cm were also associated with better survival (all P < 0.05); on multivariate analysis KPS, T stage, and GTV D90 were independent prognostic factors for survival (all P < 0.05). The incidence of pneumothorax in patients with lesions <1 cm and ≥1cm from the chest wall was 33.3% and 56.7%, respectively, and the differences were statistically significant (P = 0.026).ConclusionL-SABT showed acceptable efficacy in the treatment of unresectable early-stage NSCLC. But the incidence of pneumothorax is high. For patients with T1 stage and lesions <1 cm from the chest wall, it may have better efficacy. Prescription dose greater than 150 Gy may bring better results.

Simultaneous bilateral thoracoscopic blebs excision reduces contralateral recurrence in patients undergoing operation for ipsilateral primary spontaneous pneumothorax

ObjectiveContralateral recurrence in patients with primary spontaneous pneumothorax is approximately 15%. If positive for blebs, the recurrence rate increases to 26%. This study seeks to determine whether simultaneous contralateral video-assisted thoracic surgery blebs excision would effectively lower the contralateral incidence of pneumothorax in patients undergoing surgery for ipsilateral primary spontaneous pneumothorax. MethodsBetween January 2009 and December 2015, 335 patients with primary spontaneous pneumothorax, surgically treated in a single institution, were retrospectively studied. The median follow-up was 75 (50-99) months. All patients received video-assisted thoracic surgery blebectomy/bullectomy with pleural abrasions. They were classified into 3 groups: (1) ipsilateral video-assisted thoracic surgery without contralateral blebs/bullae included 142 patients with ipsilateral primary spontaneous pneumothorax without contralateral blebs/bullae only receiving ipsilateral video-assisted thoracic surgery; (2) ipsilateral video-assisted thoracic surgery with contralateral blebs/bullae included 123 patients with ipsilateral primary spontaneous pneumothorax with contralateral blebs/bullae receiving only ipsilateral video-assisted thoracic surgery; and (3) bilateral video-assisted thoracic surgery with contralateral blebs/bullae included 70 patients with ipsilateral primary spontaneous pneumothorax with contralateral blebs/bullae receiving 1-stage bilateral video-assisted thoracic surgery. Demographic data, perioperative details, recurrence patterns, recurrence-free survivals, and risk factors were compared. ResultsThe percentage of contralateral recurrence for the ipsilateral video-assisted thoracic surgery without contralateral blebs/bullae, ipsilateral video-assisted thoracic surgery with contralateral blebs/bullae, and bilateral video-assisted thoracic surgery with contralateral blebs/bullae groups differed significantly (0.7%, 14.6%, and 2.9%, respectively; P = .002). Multivariate analysis using the Cox proportional hazard model revealed that age less than 18 years (hazard ratio, 2.71; 95% confidence interval, 1.14-6.44; P = .024) and ipsilateral video-assisted thoracic surgery with contralateral blebs/bullae (hazard ratio, 22.13, 95% confidence interval, 2.96-165, P = .003) were predictors of contralateral recurrence, of which recurrence-free survival was notably different among groups as determined by Kaplan–Meier analysis (P < .0001). ConclusionsSimultaneous contralateral blebectomy in patients with primary spontaneous pneumothorax receiving ipsilateral video-assisted thoracic surgery significantly lowered future contralateral recurrence.

Prevalence and Risk Factors of Pneumothorax among Patients in Pediatric Intensive Care Unit

Background: Pneumothorax should be considered a medical emergency and requires a high index of suspicion and prompt recognition and intervention. Aim of the work: was to study the prevalence and risk factors of pneumothorax among children in Tanta PICU. Subjects and Methods: Sixty pediatric patients aged from 2 to 180 months (29 males and 31 females) admitted to PICU, Tanta University Hospital and were divided into 3 groups: Group 1: 20 patients on PCMV. Group II: 20 patients on HFOV: Group III: 20 non-ventilated patients. Each group was further divided into two subgroups: Subgroup I (SGI): without pneumothorax, Subgroup II (SGII): with pneumothorax. All patients were subjected to scoring systems for Pediatric Risk for Mortality (PRISM III) and Sequential Organ Failure Assessment (SOFA). They were also monitored for [pulse oximetry, blood pressure, oxygenation index, oxygenation saturation index, lung mechanics (compliance and resistance), ventilation parameters (HFOV and P-CMV) and trans-esophageal Doppler]. Results: Incidence of pneumothorax in patients on P-CMV is higher than who on HFOV and non- ventilated group. The significant risk factors of pneumothorax were HR, RR, pH, PCO2, HCO3, PaO2, SaO2, OI, MAP, FIO2, PIP, CO, CI, SVRI, SOFA and PRISM III score. X-ray showed equal results to CT chest in the diagnosis of pneumothorax without the disadvantage of exposure to high radiation accompanied the use of CT. Conclusion: Pneumothorax in P-CMV patients occur with higher ventilatory settings. Most cases of pneumothorax have underlying lung disease as pneumonia and ARDS. Mortality rate is higher among patients with pneumothorax.

Prevalence and Risk Factors of Pneumothorax among Patients in Pediatric Intensive Care Unit

Background: Pneumothorax should be considered a medical emergency and requires a high index of suspicion and prompt recognition and intervention. Aim of the work: was to study the prevalence and risk factors of pneumothorax among children in Tanta PICU. Subjects and Methods: Sixty pediatric patients aged from 2 to 180 months (29 males and 31 females) admitted to PICU, Tanta University Hospital and were divided into 3 groups: Group 1: 20 patients on PCMV. Group II: 20 patients on HFOV: Group III: 20 non-ventilated patients. Each group was further divided into two subgroups: Subgroup I (SGI): without pneumothorax, Subgroup II (SGII): with pneumothorax. All patients were subjected to scoring systems for Pediatric Risk for Mortality (PRISM III) and Sequential Organ Failure Assessment (SOFA). They were also monitored for [pulse oximetry, blood pressure, oxygenation index, oxygenation saturation index, lung mechanics (compliance and resistance), ventilation parameters (HFOV and P-CMV) and trans-esophageal Doppler]. Results: Incidence of pneumothorax in patients on P-CMV is higher than who on HFOV and non- ventilated group. The significant risk factors of pneumothorax were HR, RR, pH, PCO2, HCO3, PaO2, SaO2, OI, MAP, FIO2, PIP, CO, CI, SVRI, SOFA and PRISM III score. X-ray showed equal results to CT chest in the diagnosis of pneumothorax without the disadvantage of exposure to high radiation accompanied the use of CT. Conclusion: Pneumothorax in P-CMV patients occur with higher ventilatory settings. Most cases of pneumothorax have underlying lung disease as pneumonia and ARDS. Mortality rate is higher among patients with pneumothorax.

03:54 PM Abstract No. 409 Impact of a pleural tract sealant system on pneumothorax rates after lung biopsy at an academic institution

Recent data has demonstrated efficacy of a pleural tract sealant system (PTSS; Biosentry) in reduction of rates of pneumothorax (PTX), chest tube placement, and admissions after lung biopsy. The purpose of this study is to compare pneumothorax rate before and after utilization of the PTSS when used in an academic institution in a high risk patient population. A retrospective cohort study was performed of all CT-guided percutaneous lung biopsies at an academic institution from July 2016 to July 2018 to include approximately one year of data before and after PTSS adoption. Exclusion criteria included non-use of PTSS after official adoption, aborted procedures, and incomplete data sets. Independent variables analyzed included age, gender, presence of emphysema, pleural passes, needle in time, lobe laterality, and segment. Primary outcome was presence of a pneumothorax on initial post-biopsy chest radiograph. Data was then analyzed in an A-priori, binary logistic model adjusted for confounders (threshold for inclusion p<0.10). There were 265 patients included in the final analysis (PTSS = 150, No PTSS = 115). Only potential confounding factor meeting inclusion threshold was emphysema (p=.001). There was no difference in the overall between group rates of PTX (13% with PTSS versus 8% without PTSS; p=0.17). Binary logistic analysis discovered a higher incidence of PTX in patients with emphysema with the use of PTSS versus no PTSS. Ultimately emphysema was identified as an independent predictor of PTX in patients in which a PTSS was used (p=.047). PTSS alone or PTSS by needle time failed to be significant independent predictors. Patients with emphysema have higher rates of PTX when using a PTSS system while patients without emphysema have lower rates of post-biopsy PTX. These results suggest that using a PTSS system may be contraindicated in patients with emphysema. Additional prospective studies will be needed.

Pneumothorax after transthoracic needle biopsy of lung lesions under CT guidance.

Transthoracic needle biopsy (TTNB) is done with imaging guidance and most frequently by a radiologist, for the aim is to diagnose a defined mass. It is integral in the diagnosis and treatment of many thoracic diseases, and is an important alternative to more invasive surgical procedures. FNAC is a method of aspiration cytopathology, which with transthoracic biopsy ("core biopsy") is a group of percutaneous minimally invasive diagnostic procedures for exploration of lung lesions. Needle choice depends mostly upon lesion characteristics and location. A recent innovation in biopsy needles has been the introduction of automatic core biopsy needle devices that yield large specimens and improve the diagnostic accuracy of needle biopsy. Both computed tomography and ultrasound may be used as imaging guidance for TTNB, with CT being more commonly utilized. Common complications of TTNB include pneumothorax and hemoptysis. The incidence of pneumothorax in patients undergoing TTNB has been reported to be from 9-54%, according to reports published in the past ten years, with an average of around 20%. Which factors statistically correlate with the frequency of pneumothorax remain controversial, but most reports have suggested that lesion size, depth and the presence of emphysema are the main factors influencing the incidence of pneumothorax after CT-guided needle biopsy. On the contrary, gender, age, and the number of pleural passes have not been shown to correlate with the incidence of pneumothorax. The problem most responsible for complicating outpatient management, after needle biopsy was performed, is not the presence of the pneumothorax per se, but an increase in the size of the pneumothorax that requires chest tube placement and patient hospitalization. Although it is a widely accepted procedure with relatively few complications, precise planning and detailed knowledge of various aspects of the biopsy procedure is mandatory to avert complications.

Clinical characteristics and prevalence of pneumothorax in patients with pulmonary Mycobacterium avium complex disease

Pneumothorax in patients with pulmonary Mycobacterium avium complex (MAC) disease is considered to be a rare complication, and little is known about its clinical course. In this study, we aimed to define the clinical features, outcome, and prevalence of pneumothorax in patients with pulmonary MAC disease. A retrospective review of medical records identified eight men and ten women (mean age, 75years) with active pulmonary MAC disease complicated by pneumothorax between 2003 and 2010 in our institution. None of the patients was positive for HIV infection. Pneumothorax occurred in the right lung in 12 patients and in the left in six. All but one patient had MAC disease in both lungs, and 12 patients had widespread lesions covering a total area larger than one lung field. Seven of the 18 patients (39%) were forced to undergo surgery following unsuccessful thoracic drainage. Five patients experienced recurrence during the study period and two others eventually developed chronic pneumothorax. The complication rate of pneumothorax was calculated on the bases of the total number of patients with active pulmonary MAC disease during the same period. The overall complication rate of pneumothorax was as high as 2.4% (18 of 746 patients with MAC disease). In conclusion, the incidence of pneumothorax in patients with active pulmonary MAC disease was unexpectedly high, especially in patients who were elderly and had advanced MAC disease. This condition is often difficult to treat and can recur easily.