Pneumothorax in the Critically Ill

Abstract

Pneumothorax is a relatively frequent occurrence in the intensive care unit (ICU). It may be procedure-related, due to severe underlying pulmonary disease and/or baro/volutrauma from mechanical ventilation. Some conditions, such as the acute respiratory distress syndrome (ARDS), predispose patients to develop pneumothorax and multiple air leaks may arise in individual patients during the course of their admission. Pneumothorax can lead to significant morbidity, particularly when it is under tension. Diagnosis is challenging in the ICU environment, and relies on a combina-tion of clinical skills and a number of different imaging modalities. Management involves drainage, implementation of a ventilatory strategy to mini-mize air leak and treatment of the underlying pulmonary disorder. Occasionally, surgical inter-vention—thoracoscopy, stapling of surface blebs, pleurodesis—may be required. Recurrence rates following such interventions are reported to be low.