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Pneumothorax
- 1. Spontaneous Pneumothorax By: Dr. Ismah Reference: Management of spontaneous pneumothorax, British Thoracic Society pleural disease guideline 2010 06/08/2014 1
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- 7. Suction • Not routinely used because may cause re expansion pulmonary edema • Indicated when persistent air leak with or without incomplete re-expansion of the lung after 48 hrs • High-volume low-pressure systems such as Vernon-Thompson pumps or wall suction with low pressure adaptors 06/08/2014 7
- 8. Bronchopleural fistula • Communication between the bronchial tree and pleural space. • Persistent air leak or a failure to re-inflate the lung despite chest tube drainage for 24 h. • Chest drains inserted into the lung parenchyma • Management: - Large bore chest drains (multiple if necessary) and the use of drainage system - Refractory cases surgical repair of the air leak by thoracoplasty, lung resection/stapling, pleural abrasion/decortication 06/08/2014 8
- 9. Thoracic surgeon Indications for surgical advice: • Persistent air leak (despite 5 to 7 days of chest tube drainage) or failure of lung re-expansion. • Synchronous bilateral spontaneous pneumothorax. • Professions at risk (eg, pilots, divers). • Pregnancy. • Second ipsilateral pneumothorax. • First contralateral pneumothorax. • Spontaneous haemothorax 06/08/2014 9
- 10. Advice & f/up • Avoid air travel until 1 weeks post fully resolution • Avoid diving unless has undergone bilateral surgical pleurectomy and has normal lung function and chest CT scan postoperatively • Observation/ NA F/up in 2-4 weeks 06/08/2014 10
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Notas del editor
- PSP & SSP SSP associated with lung disease e.g. TB, COAD & symptoms more severe than PSP Size of pneumothorax not determine the severity of symptoms Tension pneumothorax cardiorespiratoy distress i.e. cyanosis, sweating, severe tachypnoea, tachycardia and hypotension Pneumothorax – erect inspiratory PA cxr displacement of pleural line CT scan for small pneumothorax
- PSP Male, young, tall & thin
- PSP referral to chest physician in 24hr, ref to thoracic surgeon if persistent air leak in 5-7 days chest tube SSP early referral, d/w thoracic surgeon if persistent air leak in 48 hrs Surgical empysema?
- The size of the pneumothorax determines the rate of resolution and is a relative indication for active intervention. Best measured by Digital radiography (Picture-Archiving Communication Systems, PACS)
- Chemical plerodesis – sclerosing agent e.g. tetracycline open or VATS approach
- AIM: resect any visible bullae or blebs on the visceral pleura and also to obliterate emphysema-like changes9 or pleural porosities under the surface of the visceral pleura.8 The second objective is to create a symphysis between the two opposing pleural surfaces as an additional means of preventing recurrence 1. Open thoracotomy and pleurectomy remain the procedure with the lowest recurrence rate (approximately 1%) for difficult or recurrent pneumothoraces. (A) 2. Video-assisted thoracoscopic surgery (VATS) with pleurectomy and pleural abrasion is better tolerated but has a higher recurrence rate of approximately 5%. (A) 3. Surgical chemical pleurodesis is best achieved by using 5 g sterile graded talc, with which the complications of adult respiratory distress syndrome and empyema are rare.