Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
Am J Emerg Med. 2012 Oct;30(8):1664.e3-4. doi: 10.1016/j.ajem.2011.09.015. Epub 2011 Nov 17.
Exacerbation of chronic obstructive pulmonary disease (COPD) is a disease pattern frequently seen in emergency medical services and intensive care units. Usually, exacerbations of COPD are of infectious origin, and an acute vital threat may take several days to develop. Tension pneumothorax in patients with COPD is a rare and often unexpected cause of acute vital threat. To the best of our knowledge, this is a unique case of CO2 narcosis after spontaneous tension pneumothorax in a patient with COPD. We describe the rapid development of respiratory insufficiency and near fatal pulmonary failure in a 65-year-old female patient with COPD due to spontaneous tension pneumothorax. The patient was in respiratory failure and comatose upon arrival of the emergency service. Before mechanical ventilation, coma could be confirmed to be due to CO2 narcosis caused by exorbitant arterial hypercapnia (PCO2, 193 mm Hg). Pneumothorax was diagnosed in the hospital by chest x-ray and resolved after pleural drainage. The patient could be extubated early and discharged without sequelae. In conclusion, we want to report the occurrence of a tension pneumothorax as an important and potentially overseen condition in patients with COPD with acute respiratory failure.
慢性阻塞性肺疾病（COPD）恶化是急诊医疗服务和重症监护病房中经常见到的疾病模式。通常，COPD 恶化是感染性的，急性生命威胁可能需要数天才能发展。COPD 患者张力性气胸是急性生命威胁的罕见且常常出乎意料的原因。据我们所知，这是一例 COPD 患者自发性张力性气胸后发生 CO2 麻醉的独特病例。我们描述了一位 65 岁女性 COPD 患者因自发性张力性气胸导致呼吸功能不全和近致命性肺衰竭的快速发展。患者到达急诊服务时呼吸衰竭和昏迷。在机械通气之前，可以确认昏迷是由于动脉血高碳酸血症（PCO2，193mmHg）引起的 CO2 麻醉所致。在医院通过胸部 X 射线诊断出气胸，并在胸腔引流后得到解决。患者可以早期拔管并出院，无后遗症。总之，我们要报告在急性呼吸衰竭的 COPD 患者中，张力性气胸是一种重要且可能被忽视的情况。
