Treatment Of Spontaneous Pneumothorax Research Articles

Retreatment after primary spontaneous pneumothoraxes managed with primary tube thoracostomy or surgery.

There is a paucity of data on later healthcare visits and retreatments after primary treatment of spontaneous pneumothorax. The main purpose of this study was to describe retreatment rates up to 5 years after primary spontaneous pneumothorax treated with either surgery or tube thoracostomy (TT) at index hospitalization in Finland between 2005 and 2018 to estimate the burden of primary spontaneous pneumothorax on the healthcare system. Retrospective registry-based study of patients with primary spontaneous pneumothorax treated with TT or surgery in Finland in 2005-2018. Rehospitalization and retreatment for recurrent pneumothorax and complications attributable to initial treatment were identified. The total study population was 1594 patients. At 5 years, 53.2% (384/722) of TT treated and 33.8% (295/872) of surgically treated patients had undergone any retreatment. Surgery was associated with a lower risk of recurrence than TT (hazard ratio (HR) 0.50, 95% confidence interval (CI) 0.43-0.56, p < 0.001). Male sex was associated with a lower risk of recurrent treatment (HR 0.75, 95% CI 0.63-0.90, p = 0.001). Higher age decreased the risk of recurrent treatment (HR 0.99, 95% CI 0.99-0.99, p < 0.001). At 5 years, 36.0% (260/722) of the TT treated and 18.8% (164/872) of the surgically treated had undergone reoperation at some point. Reintervention rates and repeat hospital visits after TT and surgery were surprisingly high at long-term follow-up. Occurrences of retreatment and reoperation were significantly higher among primary spontaneous pneumothorax patients treated with TT at index hospitalization than among patients treated with surgery.

Many years of experience of spontaneous pneumothorax treatment within one medical center

The objective: to analyze results of surgical treatment of the patients with spontaneous pneumothorax.Subjects and Methods. Medical records of patients with spontaneous pneumothorax (SP) who were treated in Surgical Thoracic Department of Ryazan Regional Clinical Hospital from 1998 to 2021 were retrospectively analyzed. The article describes the experience of treatment of 738 cases of spontaneous pneumothorax within one medical center. The evolution of tactics and principles of surgical treatment over a 23-year period is presented. The incidence of spontaneous pneumothorax and efficacy of different surgical options were analyzed. The recurrence of spontaneous pneumothorax was recorded in the following cases: after pleural cavity drainage – in 19.7%, after videothoracoscopic resection of bullous parts of the lung in combination with subtotal parietal pleurectomy – in 2.1%.

Aggressive approach for spontaneous pneumothorax treatment in children with Marfan syndrome?

Marfan syndrome (MS) is a systemic disease of connective tissues consisting of a variable combination of anomalies. These patients have an increased risk of spontaneous pneumothorax (SP). However, there is a scarcity of pediatric literature on management, and no specific guidelines exist. Our aim was to analyze the management of spontaneous pneumothorax in children and adolescents with Marfan syndrome, comparing syndromic and non-syndromic patients. Retrospective analysis of pediatric patients (18 years) with SP diagnosed at our tertiary pediatric hospital (January 10-June 22), with special emphasis on diagnosis, treatment, and follow-up (FU). Sixty-six patients with SP were identified, with nine (13%) having MS. In terms of baseline, there were no significant differences between the groups (age, sex, asthma, symptoms, and side, first-line treatment and hospitalization length). Overall, Marfan patients had significantly more first-line treatment failures requiring additional surgery, as well as more contralateral occurrences and the need for surgery/chest drain during the follow-up. Instead, conservative management resulted in significantly more ipsilateral recurrences and the need for surgery/chest drain in Marfan patients than controls during the follow-up. Treatment failure, contralateral occurrence, ipsilateral recurrence, and the need for surgery/chest drain during follow-up make management of patients with Marfan syndrome and spontaneous pneumothorax more difficult. In patients with a diagnosed MS a more aggressive first-line management should be considered, bearing in mind the higher risks of this population.

Which Role for Muscle-Sparing Posterolateral Thoracotomy in the Treatment of Spontaneous Pneumothorax?

Objective This study aims to show the place of muscle-sparing posterolateral thoracotomy in the treatment of spontaneous pneumothorax. Methods It was a single-center study performed in the Department of Thoracic Surgery of Teaching hospital Hassan II of Fez for 8 years. We adopted the nosological definition, which classifies spontaneous pneumothorax into three categories. We included patients over 15 years of age with primary or secondary spontaneous pneumothorax operated by posterolateral thoracotomy without muscle section, and we analyzed the specific indications of this approach. It included 49 patients with primary or secondary spontaneous pneumothorax, operated by muscle-sparing posterolateral thoracotomy. Data were collected from regularly updated computer files of patients, entered by Excel 2013, and analyzed using SPSS.20 software. These data are: epidemiological, clinical, radiological, surgical exploration, surgical procedure, the result of the surgery and the evolution. Results The average age was 42 years. Smoking was found in 61% of cases and pulmonary tuberculosis in 10% of cases. Thoracic computed tomography (CT) showed bullae and blebs in 31% of cases, pleural adhesions and pachypleuritis in 50% of cases, and hydropneumothorax with pachypleuritis in 37% of cases. There is a statistical correlation between pleuropulmonary decortication and pachypleuritis ( p = 0.002) or hydropneumothorax ( p = 0.001) on CT. Bullae and blebs resection was performed in 53% of cases and pleuropulmonary decortication in 63% of cases. A right pleuropneumonectomy was performed in one case. The follow-up was uneventful in 82% of cases. Conclusion Muscle-sparing posterolateral thoracotomy remains the best approach and leads to good results.

A retrospective analysis of treatment selection and risk factors of treatment failure and recurrence in patients with spontaneous pneumothorax.

Conservative observation with/without oxygen supplementation, aspiration, or tube drainage is selected as an initial treatment for spontaneous pneumothorax. In this study, we examined the efficacy of initial management for cessation of air leak and prevention of recurrence, with consideration of the degree of lung collapse. Spontaneous pneumothorax in patients who underwent initial management in our institute between January 2006 and December 2015 were included in this retrospective, single-institutional study. Multivariate analyses were conducted to identify risk factors related to the treatment failure after initial treatment and those related to ipsilateral recurrence after last treatment. Of 668 episodes of 522 patients, 198 events were initially treated by observation, 22 by aspiration, and 448 by tube drainage. Successive outcome for cessation of air leak in initial treatment was achieved in 170 (85.9%), 18 (81.8%), and 289 (64.5%) events, respectively. In the multivariate analysis for predicting failure after first treatment, previous episode of ipsilateral pneumothorax [odds ratio (OR) 1.9; 95% confidence interval (CI): 1.3-2.9; P<0.01], high degree of lung collapse (OR 2.1; 95% CI: 1.1-4.2; P=0.032), and bulla formation (OR 2.6; 95% CI: 1.7-4.1; P<0.0001) were the significant risk factors for treatment failure. Recurrence of ipsilateral pneumothorax was observed in 126 (18.9%) cases: 18 of 153 cases (11.8%) in the observation group, 3 of 18 cases in the aspiration group (16.7%), 67 of 262 cases in the tube drainage group (25.6%), 15 of 63 cases in the pleurodesis group (23.8%), and 23 of 170 cases in the surgery group (13.5%). In the multivariate analysis for predicting recurrence, previous episode of ipsilateral pneumothorax was a significant risk factor [hazard ratio (HR) 1.8; 95% CI: 1.2-2.5; P<0.001]. Predictive factors for failure after initial treatment were recurrence of ipsilateral pneumothorax, high degree of lung collapse, and radiological evidence of bullae. The predictive factor for recurrence after the last treatment was the previous episode of ipsilateral pneumothorax. Observation was superior to tube drainage in success rate to cease air leak and recurrence rate, although this effect was not statistically significant.

Effectiveness and safety of medical glue assisted argon plasma coagulation union giant emphysematous bulla volume reduction via thoracoscope on the treatment of spontaneous pneumothorax with subpleural bullae

Objective: To evaluate the effectiveness and safety of a new treatment protocol that combined "medical glue assisted argon plasma coagulation"(hereinafter called "APC plus") and "giant emphysematous bulla volume reduction"(hereinafter called "one thoracoscope plus one needle") via medical thoracoscopy on the spontaneous pneumothorax patients whose chest high resolution CT (HRCT) showed multiple subpleural bullae (SPB) and at least one SPB≥4 cm in diameter. Methods: A retrospective analysis was performed on the clinical data of 46 cases of spontaneous pneumothorax with multiple SPB(at least one SPB≥4 cm in diameter), 42 males and 4 females, aged from 31 to 79 (68.5±10.3) years,from June 2018 to December 2021 in Rizhao Hospital of Traditional Chinese Medicine. The time of air leakage discontinuance, the disappearance rate and reduction degree of target subpleural blebs one week after operation, the degree of reduction and the incidence of postoperative complications were observed. Two-year follow-up after operation was carried out to assess the recurrence rate and its short- and long-term complications. Results: Among the 46 patients, SPB disappeared or nearly disappeared in 39 cases (84.78%), decreased in number or reduced in volume in 5 cases (10.87%), and remained unchanged in 2 cases (4.35%) after the intervention of "APC Plus"; 40 patients stopped leaking within 1 week and 6 cases stopped leaking over a week. Eleven patients finished the 3-year follow-up, 13 finished 2-year follow-up and 6 finished 1-year follow-up, with only 1 relapse. No serious complications occurred in all these 46 patients. Conclusion: "APC plus" combining with "one thoracoscope plus one needle" is safe and effective in the treatment of pneumothorax patients with multiple subpleural bullae of varying sizes.

Management of the spontaneous pneumothorax in children

Introduction. Emphysematous changes in the lung tissue are the main cause of pneumothorax in children. To restore the lung function is one of the most challenging tasks in pediatric surgery.Purpose. To confirm the effectiveness of videothoracoscopy in the treatment of children with spontaneous pneumothorax.Material and methods. A retrospective analysis of case histories of 12 patients with spontaneous pneumothorax was made. Outcomes of treatment were monitored in patients during their stay in the hospital. Time of air release cessation, expansion of the lung, complications and length of stay in the hospital were analyzed.Results. In the first group of patients (n=7) only the drainage technique was used; aerostasis was achieved by the end of the second week (14.3±1.5 days). The drainage was in place till the air leakage was eliminated. The length of patient's stay in the hospital was 20.3±2.3 days. In the second group (n=5), the resection intervention was made. The complete lung expansion was achieved on the first day. Lung hermeticism was achieved by 4.2±1.3 day (p0.05). There were no any bronchopulmonary complications. The length of stay in the hospital was 14.1±1.1 days (p0.05).The advantage of the thoracoscopic technique applied for the treatment of spontaneous pneumothorax is in creating conditions for faster elimination of the source of air leakage, in accelerating functional recovery and in shortening the length of patient's stay in the hospital. The combination of thoracoscopic lung resection with pleurectomy in children can significantly reduce the risk of pneumothorax recurrence.Conclusion. To eliminate the prolonged air release in case of confirmed bullous changes in the lungs, when minimally invasive techniques are ineffective, surgical treatment in the form of video-assisted thoracoscopic resection can be applied early, even with the first episode of pneumothorax.

Drainless thoracoscopic surgery should be avoided in primary spontaneous pneumothorax with pleural adhesion.

OBJECTIVESDrainless thoracoscopic surgery, defined by omitting chest drain after surgery, has been demonstrated to be feasible in selected patients for pulmonary resection. However, drainless procedure for the treatment of primary spontaneous pneumothorax has raised concerns for its safety and thus has been less often reported. We aimed to share our preliminary experience regarding how to select patients with spontaneous pneumothorax for this procedure.METHODSA retrospective study recruiting 303 consecutive patients with the diagnosis of spontaneous pneumothorax undergoing thoracoscopic surgery in our centre from August 2016 to June 2020 was done. After careful selection, the chest drain was omitted in selected patients who underwent non-intubated uniportal thoracoscopic surgery. Patients’ clinical characteristics and perioperative outcomes were analysed.RESULTSA total of 34 patients underwent drainless thoracoscopic surgery for the treatment of spontaneous pneumothorax. Pleural adhesion was noted in 9 patients during surgery, and all of them (100%) developed residual pneumothorax, among which intercostal drainage was required in 2 (22.2%) patients and ipsilateral pneumothorax recurred 3 years after surgery in 1 (11.1%) patient. Among the remaining 25 without pleural adhesion, 17 (68.0%) developed minor residual pneumothorax (P = 0.006), which all resolved spontaneously within 1–2 weeks, with no complications or recurrence during postoperative follow-up for at least 2 years.CONCLUSIONSDrainless thoracoscopic surgery for the treatment of primary spontaneous pneumothorax is feasible but can be risky without careful patient selection. In our experience, the drainless procedure should be avoided in patients with identifiable pleural adhesion noted during surgery.

Analysis of Recurrence and Influencing Factors of Spontaneous Pneumothorax After Thoracoscopic Surgery

This study was conducted to explore the factors that are influencing the recurrence of spontaneous pneumothorax after thoracoscopic surgery. Around 110 patients with spontaneous pneumothorax who underwent thoracoscopic bullectomy in Hebei Hospital from May 2017 to May 2021 were included in this study. The patients were divided into the recurrence group (15 cases) and the non-recurrence group (95 cases), and the influences of gender, age, smoking history, height, weight, operation time, the weight of the excised tissue, number of excised pulmonary bullae, postoperative chest tube maintenance time, duration of air leakage, and length of hospital stay on the recurrence of spontaneous pneumothorax after thoracoscopic surgery were investigated. This study found that the height/weight, operation time, duration of air leakage, number of pulmonary bullae removed, weight of the removed tissue, postoperative chest tube maintenance time, and duration of hospital stay in the recurrence group was 3.2 ± 0.4, 50.9 ± 1.2, 2.1 ± 0.4, 1.6 ± 0.2, 4.2 ± 1.3, 2.4 ± 1.5 and 7.2 ± 1.5, respectively. Meanwhile, the recurrence group was 2.6 ± 0.3, 50.8 ± 1.3, 1.3 ± 0.2, 1.8 ± 0.9, 4.4 ± 1.2, 4.1 ± 1.7 and 6.9 ± 1.6, respectively. After comparing the relevant factors between the recurrence group and the non-recurrence group, it was found that there was comparability between age, height/weight, duration of air leakage and postoperative chest tube maintenance time, where these factors were shown to affect the recurrence of spontaneous pneumothorax after thoracoscopic surgery, while gender, smoking, operation time, number of resected bullae, weight of resected tissue and length of hospital stay had no effect on recurrence after spontaneous pneumothoracoscopic surgery. In short, thoracoscopic bullectomy is the best clinical treatment for spontaneous pneumothorax, however the occurrence of recurrence of spontaneous pneumothorax after the operation, which is mainly influenced by the patient’s height/weight, postoperative air leakage duration, and chest tube maintenance time. Therefore, it is essential to pay attention to the surgical treatment of the patients, and fully identify the related factors of postoperative recurrence, thereby the follow-up clinical treatment can be carried out effectively.

Video-assisted thoracoscopic (VATS) era in surgical treatment of spontaneous pneumothorax

Background: VATS is now regarded by many surgeons to be the gold standard in the surgical management of a variety of thoracic conditions, such as spontaneous pneumothorax (SP), pleural diseases, and indeterminate lung nodules. Aim and objectives: to describe different VATS techniques in patients with spontaneous pneumothorax.Summary: Several clinical management issues remain unanswered. Firstly, the duration of prolonged air leak that warrants VATS remain controversial. Current recommendations range from five days by BTS to three days advocated by our institute with more than a decade of experience with VATS for SP. Furthermore, whether VATS should be offered to all patients with low general anesthetic risk presenting with first episode of SP is unclear. Furthermore, the evolution of surgical techniques to allow ipsilateral thoracoscopic approach to treat contralateral bullous lesion may redefine the indications for CT scan in SP. Technically, the debate will continue among the surgeons on the type of VATS procedure that will minimize pneumothorax recurrence. Most surgeons will agree that some form of bullectomy (endoscopic staple or suturing) is mandatory. However, the nature of pleurodesis (mechanical, chemical, or both) that follow is often at the discretion of the individual clinician.

Association of initial management on readmissions for spontaneous pneumothorax in adolescents

BackgroundIn adolescents, initial treatment of spontaneous pneumothorax (PTX) must balance the recurrence risk with invasiveness. While institutional series have sought to define the role of early intervention, large-scale analysis is lacking. The present study aimed to evaluate the impact of initial strategy on recurrence and resource utilization in a nationally representative cohort. MethodsPatients (10–20 years) admitted for first-time pneumothorax were identified using the 2010–2019 Nationwide Readmissions Database. Based on the initial management strategy, patients were classified as nonoperative management, chest tube drainage only, and operative intervention. Multivariable regression was used to evaluate the impact of approach on outcomes of interest. The primary outcome was recurrence within 90 days, while length of stay and hospitalization costs were secondarily considered. ResultsOf an estimated 20,887 patients, 35.5% were classified as nonoperative management, 35.2% as chest tube drainage only, and 29.2% as operative intervention. Compared to others, the operative intervention cohort more frequently had Marfan syndrome and emphysematous blebs. After adjustment, patients initially managed operatively experienced lower odds of recurrence (adjusted odds ratio: 0.48, 95% confidence interval: 0.36–0.64), while chest tube drainage only had increased risk (adjusted odds ratio: 1.93, 95% confidence interval: 1.59–2.34) with nonoperative management as reference. Incremental 90-day length of stay was greater in operative intervention (β: +2.4 days, 95% confidence interval: 1.8–3.0) compared to nonoperative management, but 90-day costs were similar. ConclusionInitial operative management for first-time pneumothorax appears to reduce risk of recurrence while demonstrating similar total costs. Due to high recurrence rates associated with conservative approaches, initial surgical intervention may be considered in this patient population.

Early Approach to Primary Spontaneous Pneumothorax Treatment in Children

Objective: Etiology, diagnosis, and treatment of primary spontaneous pneumothorax (PSP) are not well-established and subject to debate in the pediatric age group. Our study aims to clarify the subject and discuss it in the light of available literature. Material and Methods: We performed a retrospective analysis of the age, sex, etiology, smoking habits, diagnostic methods, pneumothorax percentages, first treatment approach, and treatment results of the patients with PSP by examining the patients’ records. A total of 71 patients, 65 (91.5%) male and six (8.5%) female, who were followed up and treated between 2010 and 2020 were included in the study. Descriptive statistical methods, Shapiro-Wilk test Mann-Whitney U test, Pearson chi-square test, Fisher’s exact test, Fisher-Freeman-Halton exact test were used while evaluating the study data. Results: The mean age of the patients was 16.23±0.81 (13–18 years). The etiology was not clear in most of the patients. However, among them, 14 (25.5%) patients had bullae and 23 (32.4%) patients had a smoking habit. The diagnosis was made by means of taking medical history, physical examination, and post-anterior (PA) chest X-ray. Treatment with nasal oxygen was initiated in 14 (19.7%) patients with a pneumothorax percentage <20%. For a total of 57 patients the first line of treatment was initiated with tube thoracostomy. Video-assisted thoracoscopic surgery (VATS) was performed in cases where tube thoracostomy failed. Conclusion: Different forms of initial treatment modalities exist for spontaneous pneumothorax. However, we suggest that the first option in patients of the pediatric age group should be clinical follow-up and supportive treatment, if necessary, tube thoracostomy should be applied.

Uniport vats versus biport vats in treatment of spontaneous pneumothorax

Uniport vats versus biport vats in treatment of spontaneous pneumothorax

Случай развития синдрома Горнера у ребенка после оперативного лечения по поводу спонтанного пневмоторакса

In this article we present a case of Horner syndrome in a teenager occurring with thoracoscopic treatment for spontaneous pneumothorax. Horner's syndrome is a rare pathological condition caused by a lesion of the sympathetic nervous system responsible for the innervation of the eye. A brief review of the available literature data on the occurrence of this complication in spontaneous pneumothorax, its etiopathogenesis, and clinical manifestations is presented. The anamnesis, clinical picture, instrumental studies, stages of operation of this clinical case are described in detail. It is assumed that Horner's syndrome is associated with tissue damage near the stellate ganglion and nerve fibers during physical pleurodesis by argon-plasma coagulation. Key words: children, pleurodesis, Horner syndrome, spontaneous pneumothorax

Comparison of the Therapeutic Effects of a Pigtail Catheter and Chest Tube in the Treatment of Spontaneous Pneumothorax: A Randomized Clinical Trial Study.

The purpose of this study was to compare the therapeutic effects of a pigtail catheter with a chest tube in the management of patients with spontaneous pneumothorax (SP). A randomized controlled trial study was performed on patients with SP from August 2016 to December 2017 at Imam Reza Hospital, Tabriz, Iran. Forty-four patients were randomly assigned into 2 groups: group A with a 14-Fr pigtail catheter and group B using a 28-Fr chest tube. Two patients were excluded from the study. Forty-two patients participated in the study with 21 patients in each group. There were no significant differences between the groups in the patients' baseline data. The success rate was higher in patients with pigtail catheters (85.7%) than in patients with chest tubes (76.2%). However, the difference was not significant (P = .43). The procedure time was significantly shorter in the pigtail group compared to the chest tube group (P < .01). According to the visual analog scale (VAS), patients with pigtail catheters experienced milder pain during tube insertion than patients with chest tubes (P = .02). However, the pain score at the insertion site was not significantly different between the 2 groups for the first 2 days after the procedure. Patients with pigtail catheters experienced significantly less pain than patients with chest tubes during removal of the tube (P < .01). Also, there was no significant difference between the pain experienced by the 2 groups at the time of hospital discharge (P = .19). Analgesic drug usage was lower in patients with pigtail catheters compared to patients with chest tubes (P < .01). There was a trend toward lower median hospital stays demonstrated by patients with pigtail catheters compared to patients with chest tubes (P = .2). Pigtail catheters might be as effective as chest tubes for treating patients with SP in terms of lung re-expansion.

Surgical treatment of spontaneous pneumothorax in a patient with pleuropulmonary blastoma in a 2-year-old girl

Introduction. Pneumothorax is a life-threatening condition which may be the first manifestation of a tumor in the chest cavity in children.Material and methods. The article describes a clinical case of a two-year-old patient with spontaneous pneumothorax.Results. By literature data, pleuropulmonary blastoma is the most common malignant tumor of the thoracic cavity in young children. It is a thin-walled single or multi-cavity formation located on the lung periphery. It has a high risk of metastases, relapses as well as a tendency to higher malignancy degree. Therefore, the overall survival of patients is significantly reduced in case of late tumor detection. It is known that at early stages the structure of pleuropulmonary blastoma is similar to that of the bullous transformation in lungs, and in most cases it does not have characteristic clinical manifestations; therefore, early diagnostics of the neoplasm in case of pneumothorax depends on surgeon’s oncological alertness and on the tactics chosen by him/her to treat the complication. The performed videothoracoscopic resection of the cystic formation in the left lung did not only helped to achieve aerostasis within the short time, but it also helped to find out the cause of the complication: it was a rare malignant tumor of the lung - pleuropulmonary blastoma.Conclusion. The tumor process at the preoperative stage is difficult to suspect in children because in most cases there are no specific clinical symptoms. So, an active surgical tactics in treating cystic lung formations in patients with pneumothorax allows not only to eliminate the complication, but also to identify a malignant neoplasm at the initial stage.

Spontaneous Pneumothorax in a Child with COVID-19

Introduction: SARS-CoV2 (COVID-19) is a serious and global infection that has spread to numerous countries, including Iran. Pneumothorax may occur in cases of COVID-19 as a consequence of lung parenchymal damage, which can disrupt the healing process and increase mortality. Case Presentation: This manuscript describes the case of a 2-year-old boy with hyper IgM syndrome and COVID-19 infection. The patient developed spontaneous pneumothorax and recovered without chest tube by supportive care and was discharged in good general condition after the completion of the antibiotic course and cessation of fever. Conclusions: The severity, prognosis, and best treatment for spontaneous pneumothorax in COVID-19 infection, especially in children, remain nebulous. It is recommended that conservative treatment be performed if the patient has stable vital signs and no severe respiratory failure. However, this requires more detailed clinical evaluations.

Management of Bilateral Spontaneous Pneumothorax Related to COVID-19 Infection

Spontaneous pneumothorax is a rare but potentially fatal complication of coronavirus infection and COVID-19 pneumonia. Data is limited to guide clinicians in the setting of spontaneous pneumothorax when conservative management fails and operative intervention is required. We report the clinical course and operative strategy for a patient who presented with sequential bilateral spontaneous pneumothorax after being diagnosed with severe COVID-19 pneumonia. Conservative management with bilateral tube thoracostomies failed to resolve persistent alveolar-pleural fistulae, and ultimately the patient recovered after synchronous bilateral VATS blebectomies in the operating room. The timing and treatment of spontaneous pneumothorax requires follow-up education and surveillance for patients with this disease, as lack of prompt treatment outside the hospital could increase patient mortality. Spontaneous pneumothorax is a concern in patients who re-present with recurrent symptoms after COVID-19 diagnosis. When conservative treatment fails, surgery can safely be performed in COVID-19 patients with simultaneous bilateral pneumothorax with full functional recovery.

Спонтанный пневмоторакс: некоторые аспекты этиологии, патогенеза и лечения (обзор литературы)

The review article discusses the prevalence, etiology, pathogenesis, and treatment of spontaneous pneumothorax. The vascular, mechanical, obstructive, infectious, and enzymatic theories of the occurrence of emphysematous lung changes as the main cause of developing spontaneous pneumothorax are described; the role of smoking as the main etiological factor and its influence on the recurrence rate of spontaneous pneumothorax are studied. The issues of choosing primary cure tactic are considered. The effectiveness of conservative treatment, puncture and drainage of the pleural cavity as methods of treatment and pleurodesis for the prevention of recurrences of spontaneous pneumothorax are described. A comparativeassessment of various methods of pleural cavity obliteration is given: chemical pleurodesis (by sterile talc, minocycline, povidone-iodine, 50% glucose solution, autologous blood and its components, autologous adipose tissue, pseudomonas aeruginosa sensitive hemagglutinin, picibanil), apical pleurectomy, pleuroabrasion. The experience of using YAG-ND and CO2 as methods of physical pleurodesis, intraoperative Staple Line Coverage with polyglyconic acid and fibrin gel is described. The necessity of active surgical tactic in the treatment of patients with spontaneous pneumothorax developed on the base of undifferentiated connective tissue dysplasia has been substantiated. The advantages, disadvantages, indications and contrindications to different ways of surgical treatment (thoracotomy, video-assisted minithoracotomy, thoracoscopy) are discussed. The strategy for choosing treatment methods depending on the volume of pneumothorax, the severity of bullous changes, the presence of concomitant diseases, chronic obstructive pulmonary disease, and the value of the Charlson comorbidity index is considered. The expediency of using video-assisted minithoracotomy as the safest and most effective method of surgical treatment of spontaneous pneumothorax has been substantiated. The effectiveness of surgical interventions depending on the timing of their implementation is considered.

Spontaneous pneumothorax as a complication of lung injury due to COVID-19

The objective of the study: to study the course and clinical outcomes of spontaneous pneumothorax (SP) in patients with lung injury due to COVID-19.Subjects and methods. Clinical and radiation data of 11 patients (above 18 years old) with SP due to COVID-19 were retrospectively analyzed, they all were treated in the thoracic surgery department. COVID-19 was confirmed in all patients by laboratory tests. According to the chest computed tomography, the patients had signs typical of viral pneumonia and SP.Results. The surgical treatment of SP that included thoracocentesis on the pneumothorax side and closed drainage of the pleural cavity allowed resolving the pneumothorax and inflating the lung fully in 10/11 patients within 4 days on average (max = 7 days) from the moment when the surgery was done. The lethal outcome was in 1/11 (9.1%) patient which occurred 1 day after the diagnosis and successful drainage of the bilateral SP, the patient had symptoms of acute cardiovascular failure.