![]() ![]() ![]() Positive pressure applied to the lung (as used in mechanical ventilation, intermittent positive-pressure breathing, or continuous positive airway pressure therapy) can also cause pneumothoraces if the pressure is high enough to create a leak or rupture. These procedures can sometimes cause an unintentional tear or hole in the pleural lining, and air leaks from the lung into the pleural space. These include insertion of a central venous catheter or pulmonary artery catheter via subclavian veins, thoracentesis, tracheostomy, and transbronchial biopsy during bronchoscopy. ![]() In the hospitalized patient, certain invasive procedures can lead to the formation of a pneumothorax. Young, tall, thin males who have long, narrow chests have an increased incidence of spontaneous pneumothoraces of this type. 4 Some patients develop a spontaneous pneumothorax unrelated to any underlying disease. 3 Patients with AIDS can develop a spontaneous pneumothorax as a result of Pneumocystis carinii pneumonia. These problems can occur spontaneously and are, in some cases, the result of underlying lung disease, such as a ruptured or leaking bleb due to emphysema, 1 a bronchopleural fistula, 2 or a ruptured or leaking subpleural cyst in a patient with cystic fibrosis. Most pneumothoraces result from air leaking into the pleural space from within the body. The collection of air may be small and may primarily cause pain, or the pneumothorax may continue to grow, filling the pleural space, collapsing the lung, and affecting the heart and the other lung. The air can leak from the lung or can come from the atmosphere outside the body. By Bill Pruitt, RRTĪny time that air leaks into the pleural space, which lies between the parietal and visceral pleurae, a pneumothorax forms. It is important for RCPs to understand necessary treatment options for patients with pneumothoraces and chest tubes connected to drainage systems including compensating for lost volume in mechanically ventilated patients and checking the negative pressures being applied to the chest. ![]()
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