Frequency iatrogenic pneumothorax large and spots observed larly to its increase, because invasive diagnos tics and treatments are becoming more common. The app Ruge Olmsted , pcs. Minnesota, for the period from 1950 by 1974 , there were registered 102 cases of iatrogenic pneumothorax, while the number of primary spontaneous pneumothorax amounted rule 77, and secondary -64 . At the present time, apparently th, in most cases, iatrogenic pneumothorax is about the outcome, since such manipulations as transbronchial biopsy, percutaneous aspiration biopsy of the lung, catheterization of the subclavian vein, are increasingly being performed, ventilation with high positive pressure at the end of exhalation is increasingly used.
Pneumothorax can also occur as a complication of mechanical cal ventilation. Thus, out of 553 patients who underwent mechanical ventilation in 22 cases (4%) developed pneumonia motoraks . The frequency of pneumothorax is higher in patients with aspiration pneumonia (37%), chronic obstructive pulmonary disease (8%), with intubation of the right main bronchus (13%) or using positive pressure at the end of expiration (15%) . In addition, pnevmoto raksmay result from percutaneous needle biopsy of lung (24%) [51J, transbronchial biopsy lay one (5.5%) , biopsy pleura (3%) or thoracentesis (2%). These figures are probably underestimated, since the authors of the articles usually have more experience in the implementation of time personal manipulation than the average doctor.
Iatrogenic pneumothorax may develop after a tracheostomy if air enters the mediastinum or pleural cavity through the cervical fascia or complicates the puncture of the internal jugular vein and catheterization of the subclavian vein. Iatrogenic pneumothorax often develops during Rean mation using AIC. In one series of observations at necropsy revealed that 12 patients had eg adjoint pneumothorax, are not diagnosed during life, nine five of these patients in the past were performed cardiopulmonary resuscitation . In 3 of 9 patients, a rib fracture that occurred during resuscitation was also detected.
Clinical picture
The clinical picture of the course of iatrogenic pneumothorax is determined by both the patient’s condition and the type of intervention that caused the pneumothorax. If pneumothorax emerged as wasps complication in themechanical ventilation, the patient’s clinical condition suddenly deteriorates. Accurate indicator devel pneumothorax ment orator pneumothorax during cardiopulmonary resuscitation svi fies the occurrence of difficulties in providing mechanical tion ventilation. In contrast, pneumothorax following thoracentesis , pleural biopsy, transbronchial Biop This or percutaneous aspiration biopsy of the lung may not have clinical symptoms.
Diagnostics
The diagnosis of iatrogenic pneumothorax should be borne in mind, COH yes during mechanical ventilation is deteriorating clinical status of patients when performing cardio-le of pulmonary resuscitation there are difficulties in providing mechanical ventilation or observed electromechanical dissociation, as well as the appearance of shortness of breath after a medical or surgical manipu of Iatrogenic pneumothorax accompanied by the same signs and symptoms such as primary or secondary pneumonia motoraks. The final diagnosis is established on the basis of radiological data.
Treatment
Treatment iatrogenic pneumothorax different from the treatment of spontaneous pneumothorax, since relapses less probability us. If pneumothorax occurs during ventilation with CREATE Niemi positive pressure and lead to respiratory or cardiovascular failure, should immediately about lime torakostomiyu and e renirovanie pleural cavity . When ventilating with positive PRESSURE Nia air enters the active extrapulmonary space that prevents the closure of the defect and may lead to the development of tension pneumothorax. If mechanical ventilation is continued, then after cessation of air leakage, drainage follows blowing left in the pleural cavity is not less than 48 hours. In some cases the resulting bronchopleural fistula is so great that when the bulk of the incoming venti air lyatsii teas, as already mentioned, the only way to ensure Nia adequate breathing is need for high use hydrochloric ventilation .
Pneumothorax that develops as a result of medical intervention can occur as asymptomatic, and with you the expressions of clinical symptoms until the heavy races stroystva breathing. If pneumothorax appears insignificant -inflammatory symptomatic or asymptomatic and is less than 40% of the hemithorax , the patient should be kept under on the observation. It is possible to accelerate the elimination of pneumothorax by introducing oxygen . If pneumothorax is accompanied by severe symptoms and takes up more than 40% of hemithorax or continues to increase in volume, removal of air from the pleural cavity.
If formed as a result of pneumothorax thoracentesis or pleural biopsy, when air is bad formed manipulation enters the pleural cavity through a gap not lay com, and from the atmosphere. For the treatment of these patients can be recom mendovat-therapeutic matic thoracentesis . If the patient was performed a biopsy of the pleura, it should be very Atte tion inspect the scene of a biopsy. In some patients, especially thin, with poor tissue turgor, after the biopsy, air continues to flow into the pleural cavity through the puncture canal. In such cases, the puncture site should take in ki webbing suture.
If pneumothorax is the result of percutaneous needle biopsy of lung or transbronchial biopsy, as well as if the therapeutic thoracentesis after biopsy pleural not improve the patient’s condition, it is required torakostomiya with the Introduction drainage deniem. vaniyu is obstruction of the main bronchus. If drainage is introduced to a patient with bronchial obstruction, then the lung will not straighten and fill the hemithorax , which can lead to the formation of empyema. Therefore, if before the manipulation did not straighten the entire lung, the patient should make a reservation. Hoscopy to identify obstruction of the bronchus. Usually re result torakostomii easy to quickly straightened and after 48 h air flow stops completely. After straightening the light and stop the flow of air drainage pipe of should be left in the pleural cavity of a further 24 hours. In some patients, the air flow can not pre clearly reduced for a few days. Our experience shows that in such cases, create a pleurodesis and will do to stop of the air can be achieved by introducing into the pleural cavity wall ratsiklina .